This is one of the most common — and most misunderstood — questions in senior healthcare. Millions of Americans assume that Medicare will cover the cost of a nursing home when the time comes. It won’t. At least, not the way most people expect.
This is the complete, honest answer — so you can plan accordingly.
The Short Answer
Medicare covers skilled nursing facility (SNF) care for up to 100 days under specific conditions. It does not cover long-term custodial care in a nursing home.
That distinction — between skilled nursing care and custodial care — is everything.
What Medicare Part A Covers for Skilled Nursing Facility Care
Medicare Part A will pay for a stay in a skilled nursing facility, but only when all of the following conditions are met:
- You had a qualifying inpatient hospital stay of at least 3 consecutive days (not counting the discharge day)
- You are admitted to a Medicare-certified skilled nursing facility within 30 days of leaving the hospital
- You need skilled care — such as skilled nursing services, physical therapy, or occupational therapy — on a daily basis
- A doctor has certified that you need this level of care
If you meet these conditions, here’s what Medicare Part A pays:
- Days 1–20: Medicare covers 100% of the cost. You pay nothing.
- Days 21–100: You pay a daily copayment of $204.50 (2025 rate). Medicare covers the remainder.
- After day 100: Medicare pays nothing. You are responsible for the full cost.
That copayment adds up quickly — the total out-of-pocket cost for days 21 through 100 is roughly $16,360. And after day 100, you’re entirely on your own.
What “Skilled Nursing Care” Actually Means
Medicare defines skilled nursing care as care requiring a licensed nurse or therapist on a daily basis — things like IV injections, physical therapy after a hip replacement, complex wound care, or management of a feeding tube. The key word is skilled. If the care could be provided by someone without professional medical training, Medicare considers it custodial — and won’t cover it.
What “Custodial Care” Means — and Why Medicare Doesn’t Cover It
Custodial care is the kind of help most nursing home residents need daily — bathing, dressing, eating, transfers in and out of bed, supervision for cognitive impairment like Alzheimer’s, and medication reminders.
This is the care that defines most long-term nursing home stays. And Medicare does not pay for it — regardless of how long you’ve paid into the system, your age, or your medical condition. This is the gap that catches most families off guard.
What About Medicare Advantage Plans?
Medicare Advantage (Part C) plans must provide at least the same SNF coverage as Original Medicare. Some offer modest extras like reduced copayments during the 21-100 day window. However, no Medicare Advantage plan covers long-term custodial nursing home care. The fundamental limitation is the same: Medicare — in any form — is a medical insurance program, not a long-term care program.
What Medicaid Covers That Medicare Doesn’t
The real safety net for long-term nursing home care is Medicaid.
Medicaid is a joint federal and state program that does cover long-term custodial care in a nursing home. In fact, Medicaid is the single largest payer of long-term nursing home care in the United States, covering roughly 60% of all nursing home residents.
But Medicaid is a needs-based program. You must meet strict financial eligibility requirements to qualify.
How to Qualify for Medicaid Long-Term Care
Medicaid eligibility for nursing home care is based on both your medical need and your financial situation. Here’s how it generally works:
Medical Eligibility
You must require a nursing facility level of care — meaning you need daily assistance with activities that a nursing home provides. A medical assessment determines this.
Financial Eligibility
In most states, including Florida, your countable assets must be below approximately $2,000 to qualify. Certain assets are exempt — your primary home (up to roughly $713,000 in equity), one vehicle, personal belongings, and prepaid funeral plans. Your monthly income must also fall within state limits, though a Qualified Income Trust (Miller Trust) can help you qualify if your income is too high for Medicaid but not enough to pay privately.
The Medicaid Spend-Down
If your assets exceed Medicaid’s limits, you must spend down — using your own money to pay for care — until your assets reach the qualifying threshold.
Key things to understand: you cannot give away assets to qualify faster — Medicaid applies a 5-year look-back period and penalizes transfers. A community spouse is protected by the Community Spouse Resource Allowance, which lets them keep a portion of the couple’s assets. An elder law attorney can help you navigate this process and protect assets where possible.
The Gap Between Medicare and Medicaid
The problem for many families: Medicare won’t cover long-term care, Medicaid requires exhausting most savings first, and private-pay costs run $9,000 to $10,000+ per month. That gap can consume a lifetime of savings in months. For a complete overview of funding options, see how seniors are paying for long-term care in 2026. Planning ahead is critical.
What If You Have Life Insurance?
If you own a life insurance policy, you have an asset that many families overlook during this difficult time.
Through a life settlement, you can sell your policy to a licensed buyer for a lump-sum cash payment — often approximately 4 times what the insurance company would offer as a surrender value. This cash can pay for nursing home care during the private-pay period before Medicaid, supplement your spouse’s income, eliminate burdensome premiums, or fund the gap between what Medicare covers and what you owe.
Life settlement payouts vary based on age, health, and policy size. A licensed life settlement broker will represent your interests, shop your policy to multiple buyers, and work to get you the best possible offer. Check the qualification criteria to see if a life settlement might work for your situation.
This option isn’t right for everyone — if your family depends on the death benefit, selling may not make sense. But if the policy is no longer needed for its original purpose, it may be worth more as cash today than as a future payout. Learn about how to pay for nursing home care for a full look at your options.
Filling the Gaps Medicare Leaves Behind
The gap between what Medicare covers and what nursing home care actually costs is real — but it doesn’t have to be devastating. The more you understand now, the better prepared you’ll be.
If you own a life insurance policy and want to know what it might be worth, we can help with that step.
Have a life insurance policy you no longer need? It could help fill the gap Medicare won’t cover. Get a free estimate or call (321) 270-0279.