In 2026 Original Medicare pays all of days 1 to 20 in a skilled nursing facility, you pay $217 a day for days 21 to 100, and you pay all costs from day 101 (CMS, 2026 Medicare Parts A and B Premiums and Deductibles fact sheet, November 14, 2025; Medicare.gov, Skilled nursing facility care, checked October 14, 2026).
The short answer
Medicare pays for a short stay in a skilled nursing facility after a hospital stay, for skilled nursing or rehab. It does not pay for a long stay in a nursing home when the only help you need is custodial care, such as bathing, dressing or eating.
Medicare.gov puts it plainly: Medicare generally does not cover long-term nursing home stays unless you are receiving skilled nursing care (Medicare.gov, Nursing home care, checked October 14, 2026). Part A limits skilled nursing facility coverage to 100 days in each benefit period (Medicare.gov, Skilled nursing facility care, checked October 14, 2026).
| Days in a skilled nursing facility, 2026 | What you pay with Original Medicare |
|---|---|
| Days 1 to 20 | $0 after the $1,736 Part A deductible (not owed again if you already paid it for the hospital stay in the same benefit period) |
| Days 21 to 100 | $217 a day |
| Day 101 and on | All costs |
Amounts: Medicare.gov, Skilled nursing facility care, checked October 14, 2026; CMS, 2026 Medicare Parts A and B Premiums and Deductibles fact sheet, November 14, 2025. The daily amount for days 21 to 100 was $209.50 in 2025 (same fact sheet). A benefit period ends when you have gone 60 days in a row without skilled nursing facility care (CMS, Medicare and You handbook, Product No. 10050, September 2026).
The 3-day rule and the observation trap
Medicare covers skilled nursing facility care only after a qualifying inpatient hospital stay of at least 3 days in a row. The day you are admitted as an inpatient counts; the day you leave does not (Medicare.gov, Skilled nursing facility care, checked October 14, 2026).
Time in the emergency room or under observation does not count, even if you stay overnight in a regular hospital bed (CMS, Medicare Hospital Benefits, Product No. 11435, December 2025). CMS gives this example: one day in observation, then two days as an admitted inpatient, is not a qualifying stay (same source).
Federal law requires a hospital to give you a written notice, with an oral explanation, if you receive observation services as an outpatient for more than 24 hours, no later than 36 hours after they start (42 U.S.C. 1395cc(a)(1)(Y), checked October 14, 2026). If you were admitted and the hospital later changed your status to outpatient observation, you may be able to appeal (Medicare.gov, Skilled nursing facility care, checked October 14, 2026).
Two exceptions: some doctors in an Accountable Care Organization (ACO) with a 3-day rule waiver, and some Medicare Advantage plans, do not require the 3-day stay (Medicare.gov, Skilled nursing facility care, checked October 14, 2026). Ask before discharge.
What counts as skilled care, and when coverage stops
To qualify, you must enter the facility within a short time (generally 30 days) of leaving the hospital, and a doctor must decide you need daily skilled care, such as intravenous medicines or physical therapy, given by or under the supervision of skilled staff (Medicare.gov, Skilled nursing facility care, checked October 14, 2026). The facility must be Medicare-certified (same source).
Skilled care can be needed to improve your condition, or to maintain it or slow its decline (same source). Coverage can end before day 100 if you no longer need daily skilled care. If you think covered services are ending too soon, you can ask for a fast appeal; the provider must give you a notice before services end that explains how, and if you do not get it, ask for it (CMS, Medicare and You handbook, Product No. 10050, September 2026).
Assisted living, memory care and home care
Medicare and most health insurance, including Medigap, do not pay for non-medical long-term care, whether it is given at home, in the community, in an assisted living facility or in a nursing home (CMS, Medicare and You handbook, Product No. 10050, September 2026). That means Medicare does not pay assisted living rent or memory care fees.
Medicare can pay for home health care if you are homebound and need part-time or intermittent skilled care. It does not pay for 24-hour care at home, homemaker services unrelated to your care plan, or custodial care when that is the only care you need (Medicare.gov, Home health services, checked October 14, 2026). A home health aide is covered only while you also get skilled nursing or therapy (same source).
Medigap and Medicare Advantage
Medigap plans C, D, F, G, M and N pay the full skilled nursing facility coinsurance; Plan K pays 50% and Plan L pays 75%; Plans A and B do not pay it (CMS and NAIC, Choosing a Medigap Policy, Product No. 02110, March 2026). No Medigap plan pays for long-term custodial care (same source).
Medicare Advantage plans may charge copayments during the first 20 days (Medicare.gov, Skilled nursing facility care, checked October 14, 2026). For nursing home care, Medicare.gov says plans usually do not help pay unless the nursing home has a contract with the plan (Medicare.gov, Nursing home care, checked October 14, 2026). Free, unbiased help is available from your State Health Insurance Assistance Program (SHIP).
When Medicare's skilled nursing benefit works well
For a short recovery, such as rehab after a hip replacement or a stroke, the benefit is strong. In 2026 the first 20 days cost nothing after the deductible (Medicare.gov, Skilled nursing facility care, checked October 14, 2026), and Medigap plans C, D, F, G, M and N pay the full coinsurance for days 21 to 100 (CMS and NAIC, Choosing a Medigap Policy, Product No. 02110, March 2026). It is designed for recovery, not for years of care. If a long stay looks likely, start planning for the cost while the skilled stay is still covered; see how much long-term care costs and Medicaid spend-down.
A plain example: a 130-day nursing home stay in 2026
Hypothetical: after a 4-day inpatient stay (Part A deductible already paid), a widow enters a Medicare-certified skilled nursing facility and gets daily skilled care for 100 days. On day 101 she still needs help with daily living and stays 30 more days as a private-pay resident at the national semi-private median of $315 a day (CareScout Cost of Care Survey 2025, data tables dated March 2, 2026). Coinsurance: $217 a day for days 21 to 100 in 2026 (CMS, 2026 Medicare Parts A and B Premiums and Deductibles fact sheet, November 14, 2025).
| Period | Arithmetic | Original Medicare only | With Medigap Plan G |
|---|---|---|---|
| Days 1 to 20 | $0 (Part A deductible already paid for the hospital stay in this benefit period) | $0 | $0 |
| Days 21 to 100 | 80 days x $217 = $17,360 | $17,360 | $0 |
| Days 101 to 130 | 30 days x $315 (national semi-private median) = $9,450 | $9,450 | $9,450 |
| Total for 130 days | $26,810 | $9,450 |
Plans C, D, F, M and N also pay the days 21 to 100 coinsurance in full (CMS and NAIC, Choosing a Medigap Policy, Product No. 02110, March 2026). Plans K and L pay 50% and 75% of it until a yearly out-of-pocket limit is reached, $8,000 for Plan K and $4,000 for Plan L in 2026 (Medicare.gov, Compare Medigap plan benefits, checked October 14, 2026). No plan pays the $9,450 for days 101 to 130. Many stays end well before day 100: the federal LongTermCare.gov site gives the average Medicare-covered stay as 22 days (ACL, LongTermCare.gov, Who Pays for Long-Term Care?, last modified May 10, 2022). From day 101 on, every month at that daily rate costs about $9,581 ($315 x 365 / 12).
Red flags
- A hospital stay where nobody can tell you whether you are an inpatient or under observation.
- A discharge plan that sends you to a nursing facility before anyone confirms you had a 3-day inpatient stay.
- Being told Medicare will pay for a long-term stay because the facility is Medicare-certified.
- A notice that coverage is ending with no explanation of how to appeal.
- A Medicare Advantage plan you joined without checking which nursing facilities are in its network.
- Assisted living or memory care marketed as if Medicare will help pay.
- Pressure to switch Medicare coverage during a hospital stay.
- Someone who offers to speed up a Medicaid application if you hand over control of accounts.
- Home care agencies that bill Medicare for services you did not get; read every Medicare Summary Notice.
- A facility that asks family members to sign as financially responsible parties without explaining it.
Questions to ask before you sign
- Am I an inpatient or an outpatient under observation right now?
- Has a doctor written an order admitting me as an inpatient, and on what date?
- Will my stay count as a qualifying 3-day inpatient stay for skilled nursing facility coverage?
- Does my doctor or my Medicare Advantage plan waive the 3-day rule?
- Is this skilled nursing facility Medicare-certified and in my plan's network?
- What daily skilled care am I getting, and what are my goals for discharge?
- How many skilled nursing days have I used in this benefit period?
- What will I owe per day after day 20, and does my Medigap or other coverage pay it?
- If Medicare coverage ends, what is your private daily rate, and do you accept Medicaid?
- How do I appeal if I am told my coverage is ending?
Long-Term Care and Your Home: Read This Before You Sign
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Sources
- Medicare.gov, Skilled nursing facility care, checked October 14, 2026
- CMS, 2026 Medicare Parts A and B Premiums and Deductibles fact sheet, November 14, 2025
- CMS, Medicare Hospital Benefits, Product No. 11435, December 2025
- Medicare.gov, Nursing home care, checked October 14, 2026
- Medicare.gov, Home health services, checked October 14, 2026
- CMS, Medicare and You handbook, Product No. 10050, September 2026
- CMS and NAIC, Choosing a Medigap Policy, Product No. 02110, March 2026
- Cornell LII: 42 U.S.C. 1395cc, agreements with providers of services (checked October 14, 2026)
The Retirement Literacy Foundation is a 501(c)(3) public charity. This page is general education, not tax, legal or investment advice. Nothing is sold here, no product is recommended, and RLF accepts no funding from financial companies. Rules and figures change; each one above shows its source and date. Check anything you plan to act on with your state insurance department or a qualified professional who is not paid on the product.