Does Medicare Cover Nursing Home Costs? Understanding the Limits of Coverage
The answer is yes. But only for short-term, skilled recovery.
The question of whether Medicare covers nursing home costs is common. And for families facing long-term care decisions, getting the answer can be confusing too. The short answer is Medicare Part A will cover specific, short-term stays in a Skilled Nursing Facility (SNF)—but it does not cover long-term custodial care in a nursing home.
At Maple Leaf Health Care Center in Manchester, New Hampshire we help residents and families navigate the complexities of Medicare. Whether your needs are for short-term rehabilitation under Medicare or long-term residency supported by Medicaid. Our job is to provide the answers and care you need.
On this page we’ll explain what Medicare covers, where its coverage ends, and how we help transition residents to permanent long-term care.
The Critical Distinction: Skilled Care vs. Custodial Care
Medicare’s entire coverage policy hinges on the difference between two types of care. If the care is strictly custodial, Medicare will pay nothing.
Medicare’s Focus: Skilled Nursing Facility (SNF) Care
Medicare Part A covers care in an SNF only when it meets a clinical need for Skilled Care. This care is medically necessary, ordered by a doctor, and must be administered by or under the supervision of licensed medical professionals (like Registered Nurses or Physical Therapists).
Examples of Skilled Care (Covered):
- Complex wound care and sterile dressing changes.
- Intravenous (IV) injections or feedings.
- Daily physical, occupational, or speech therapy for recovery.
- In-depth monitoring of an unstable, acute medical condition.
The Exclusion: Custodial Care (Not Covered)
The majority of long-term care in a nursing home is Custodial Care. This care helps with routine daily living but does not require licensed medical personnel to administer it.
Examples of Custodial Care (Not Covered):
- Assistance with activities of daily living (ADLs), such as bathing, dressing, and toileting.
- Help with eating and mobility (e.g., moving from bed to chair).
- General supervision and assistance for safety or cognitive impairment (e.g., dementia).
Key Takeaway: Medicare is designed to help you recover from an acute event and return home. It is not designed to help you live permanently in a facility.
The Strict Rules for Medicare SNF Coverage
Even if you require skilled care, Medicare coverage is only triggered if you meet three specific criteria, collectively known as the Medicare Skilled Nursing Facility (SNF) Eligibility Flow:
The 3-Day Inpatient Stay Rule
To qualify for any SNF coverage, you must have a medically necessary inpatient hospital stay of at least three consecutive days.
- Crucial Detail: Time spent in the Emergency Room or under “Observation Status” does not count toward the three-day requirement. You must be formally admitted as an inpatient.
The 30-Day Window
You must be formally admitted to a Medicare-certified Skilled Nursing Facility (like Maple Leaf Health Care Center) within 30 days of your hospital discharge.
The Daily Skilled Requirement
The services received in the SNF must be medically necessary daily skilled nursing care or rehabilitation services.
The 100-Day Limit: Costs and Co-Pays (2025 Rates)
When all eligibility criteria are met, Medicare Part A covers a limited number of days per benefit period. A benefit period starts the day you are admitted to a hospital or SNF and ends when you have been out of both for 60 consecutive days.
Medicare coverage for a skilled stay is capped at 100 days, with costs shifting significantly after the first 20 days.
| Days in the Skilled Nursing Facility | Patient Cost per Day (2025 Rate) | Payer Responsibility |
| Days 1–20 | $0 | Medicare pays 100% of the cost. |
| Days 21–100 | $209.50 | The patient pays a daily co-insurance. Medicare pays the rest. |
| Days 101 and beyond | 100% of Cost | Medicare pays nothing. The patient is responsible for all costs. |
Important Note on Supplements (Medigap): Many Medigap plans (like Plan F or G) will cover the daily co-pay of $209.50 for days 21 through 100, but no Medicare plan covers costs after Day 100.
The Long-Term Solution: Why Medicaid is the Primary Payer
When the 100 days expire, or the resident no longer requires daily skilled care and transitions to needing permanent assistance with ADLs (custodial care), Medicare coverage ends. This is the moment families realize they must transition to a long-term funding source.
As detailed in our New Hampshire Medicaid Guide, Medicaid is the primary payer for long-term care because, unlike Medicare, it is an assistance program designed to cover:
- Permanent Stays: Indefinite care for chronic conditions.
- Custodial Care: Assistance with bathing, dressing, mobility, and feeding.
- Room and Board: Covers the basic costs of living in a facility.
Maple Leaf Health Care Center is proudly a Medicaid-certified facility. We understand that many residents utilize Medicare for their initial rehabilitation phase and then transition to long-term funding through New Hampshire Medicaid (NH EASY) if they meet the strict functional and financial eligibility criteria.
At Maple Leaf Health Care Center, we ensure every resident receives the same high standard of dignity and clinical excellence, regardless of their insurance payer.
5. Next Steps for New Hampshire Families
If your loved one is currently in the hospital and preparing for a discharge to a Skilled Nursing Facility, or if you anticipate the need for long-term care beyond Medicare’s limits, here is how Maple Leaf can help:
- Admissions Consultation: Our admissions team works with hospital discharge planners to verify that your loved one meets the “3-Day Rule” and medical necessity requirements for Medicare SNF coverage at our facility.
- Financial Planning: If long-term care is anticipated, we can discuss the requirements for New Hampshire Medicaid eligibility, including the annual income limits (approx. $2,901 gross monthly income in 2025) and the asset limit ($2,500 for a single applicant).
- Local Resources: We encourage families to contact ServiceLink, New Hampshire’s Aging and Disability Resource Center, or an elder law attorney to discuss the complex application, “spend-down” requirements, or spousal protections.
Contact Maple Leaf Health Care Center today to schedule a tour or to speak with our admissions department about your loved one’s unique care needs.
