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What Medicare pays for in a nursing home, and what it does not
This is the most expensive misunderstanding in senior care. Medicare does not pay for long-term nursing home care. It pays for a limited stretch of skilled care after a hospital stay, and families routinely discover the difference in the fourth week.
The benefit that exists
Medicare Part A covers care in a skilled nursing facility when someone needs skilled nursing or therapy — wound care, IV medication, rehabilitation after a fracture or a stroke. The stay must follow a qualifying inpatient hospital admission, and coverage runs for up to 100 days in a benefit period.
Days 1 through 20 carry no coinsurance. Days 21 through 100 carry a daily coinsurance amount that changes every January — this page does not print it, because a stale dollar figure about money someone is about to owe is worse than no figure. Medicare publishes the current amount.
The trap: three inpatient days, and what "inpatient" means
The skilled nursing benefit generally requires a hospital stay of at least three consecutive days as an admitted inpatient, not counting the day of discharge. The word doing the work there is inpatient.
A hospital can keep someone for two nights under observation status — in a bed, on a ward, receiving treatment — and none of it counts toward the three days, because observation is billed as outpatient care. Families discover this after the transfer, when the nursing home bill arrives in full. It is worth asking the hospital directly, in these words: has my parent been admitted as an inpatient, or are they under observation?
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 29 nursing homes published on this site carry 621 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?
Not for long-term care, which is what most families mean by the question. Medicare Part A covers a limited stay in a skilled nursing facility after a qualifying inpatient hospital admission — up to 100 days per benefit period, and only while skilled care is still needed. It does not pay for custodial long-term care at any point, however long someone needs it.
What is the three-day rule for Medicare skilled nursing coverage?
Medicare's skilled nursing benefit generally requires a hospital stay of at least three consecutive days as an admitted inpatient, not counting the day of discharge. Time spent in the hospital under observation status does not count toward it, even when it is spent in a hospital bed overnight — which is the most common way families are surprised by a bill.
How long does Medicare pay for skilled nursing care?
Up to 100 days in a benefit period. Days 1 through 20 carry no coinsurance. Days 21 through 100 carry a daily coinsurance amount that changes each January, so check the current figure on Medicare's own site rather than any secondhand page. Coverage can also end before day 100, whenever the care a person still needs stops being skilled care.
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.