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What Medicare pays for in a nursing home, and what it does not
Medicare does not cover custodial long-term care. It may cover limited skilled nursing facility care when eligibility requirements are met. Costs and hospital-stay requirements can differ between Original Medicare and Medicare Advantage.
The benefit that exists
Original Medicare Part A may cover up to 100 days of skilled nursing facility care per benefit period when eligibility requirements are met. Skilled nursing or therapy can include wound care, IV medication, or rehabilitation after a fracture or stroke. Coverage is not a guaranteed 100-day stay: eligibility must continue.
For covered care under Original Medicare, days 1–20 have no daily coinsurance after the Part A deductible is met. You do not pay that deductible again if you already paid it for hospital care in the same benefit period. Days 21–100 have daily coinsurance. Check Medicare’s current skilled nursing coverage, eligibility requirements and costs.
Medicare Advantage plans may charge copayments during the first 20 days. Ask your plan about your costs and coverage before transfer.
The three-day rule and its exceptions
Original Medicare generally requires three consecutive days as an admitted inpatient, not counting discharge day. Time under observation status does not count toward those days, even when spent in a hospital bed overnight.
Some approved Accountable Care Organization arrangements waive the three-day requirement. Medicare Advantage plans may also waive it. Ask the hospital or your plan whether a waiver applies and whether your skilled nursing stay will be covered before transfer.
What Medicare does not pay for
Custodial care — help with bathing, dressing, eating, using the bathroom and moving safely. That is the great majority of what a long-term nursing home stay actually consists of, and Medicare does not cover it at 20 days, at 100 days, or at any point after.
Long-term care is generally paid privately, through a long-term care insurance policy, or by Medicaid for those who meet its income and asset rules. Medicaid rules are set state by state and are genuinely complicated; Texas administers its own. This page is not the place to work out which applies to a particular family, and it does not try.
This is general information, not medical advice. It describes what Texas and Medicare require, not what any particular person needs. Talk to your parent's physician about their specific situation.
Why the inspection record still matters
Whoever pays, the facility's record is the same record. Medicare publishes star ratings, payroll-based staffing, every citation with its scope and severity code, and every fine, for every certified nursing home in the country — including the ones a family pays for entirely out of pocket. The 46 nursing homes published on this site carry 1000 health citations between them, and the letter attached to each one is the most useful thing on the record.
Common questions
Does Medicare pay for a nursing home?
Medicare does not cover custodial long-term care. Original Medicare Part A may cover up to 100 days of skilled nursing facility care per benefit period when eligibility requirements are met. A qualifying inpatient hospital stay is generally required, but approved waivers exist. Ask your Medicare Advantage plan about its coverage rules if you have one.
What is the three-day rule for Medicare skilled nursing coverage?
Original Medicare generally requires at least three consecutive inpatient hospital days, excluding discharge day. Observation time does not count. Some approved Accountable Care Organization arrangements and Medicare Advantage plans waive the requirement. Ask the hospital or your plan whether a waiver applies before transfer.
How long does Medicare pay for skilled nursing care?
Original Medicare Part A may cover up to 100 days per benefit period while eligibility continues. Covered days 1–20 have no daily coinsurance after the Part A deductible is met; it is not charged again if already paid for hospital care in that benefit period. Days 21–100 have daily coinsurance. Medicare Advantage plans may charge copayments during the first 20 days. Check Medicare or your plan for current costs and requirements.
What is custodial care, and who pays for it?
Custodial care is help with daily living — bathing, dressing, eating, moving safely — that does not require a nurse or therapist to deliver. It is the great majority of what a long-term nursing home stay consists of, and Medicare does not cover it. It is generally paid privately, by a long-term care insurance policy, or by Medicaid for those who qualify.
Look up a facility: every Medicare-certified nursing home published here, with its ratings, staffing, fines and full citation history.