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Medicare and Medicaid pay for different kinds of nursing-home care. Original Medicare Part A can pay for a short, medically necessary skilled-nursing-facility (SNF) recovery after a qualifying inpatient hospital stay. In 2026, after the Part A deductible, covered SNF days 1–20 cost $0 per day, days 21–100 cost $217 per day, and day 101 onward is entirely the resident’s responsibility. Medicare generally does not pay for ongoing custodial nursing-home care.
Medicaid is the main public payer for long-term nursing-facility care. It can continue beyond Medicare’s 100-day SNF limit when the resident meets the state’s financial rules and nursing-facility level-of-care standard and lives in a Medicaid-certified facility. The resident usually contributes most available income after protected deductions, so there is no single national Medicaid payment amount.
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Medicare and Medicaid at a glance
The fastest way to distinguish the programs is to identify the care being provided. Medicare is health insurance for a limited recovery episode. Medicaid is a needs-based program that can finance continuing nursing-facility residence.
| Question | Medicare Part A (Original Medicare) | Medicaid nursing-facility benefit |
|---|---|---|
| Primary purpose | Short-term skilled nursing and rehabilitation after a qualifying hospitalization | Ongoing nursing-facility care, including custodial support, for people who meet state eligibility rules |
| Maximum duration | Up to 100 SNF days in a benefit period, if coverage requirements continue | Potentially ongoing while financial eligibility, medical need and facility requirements continue |
| Clinical test | Daily medically necessary skilled care ordered by a clinician | State nursing-facility level-of-care determination |
| Financial test | No Medicaid-style income or asset test for Part A entitlement | State income, resource and other Medicaid eligibility rules |
| Facility | Medicare-certified SNF | Medicaid-certified nursing facility |
| Resident payment | Part A deductible and daily coinsurance under the applicable schedule | Post-eligibility income contribution, plus permitted extra charges |
| Long-term custodial care | Generally excluded | Core purpose of the institutional benefit for eligible residents |
Medicare can still pay covered physician, hospital, prescription-drug and medical-supply services while someone lives in a nursing home. That does not turn the nursing-home room and daily custodial assistance into a Medicare-covered benefit.
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When Medicare pays for a nursing-home stay
Medicare Part A covers a defined SNF episode, not an indefinite nursing-home residence. All of the following conditions generally have to be met:
- Qualifying inpatient hospitalization: The person has a medically necessary inpatient hospital stay of at least three consecutive days. Time recorded as outpatient observation does not count toward the three days.
- Timely SNF admission: The person enters the SNF within the applicable Medicare admission window after the hospitalization.
- Daily skilled need: A doctor certifies that daily skilled nursing or skilled rehabilitation is medically necessary. Assistance with routine activities alone does not satisfy this test.
- Certified provider: The facility is certified by Medicare to provide SNF services.
- Available benefit days: The person has remaining days in the current Medicare benefit period.
What a covered SNF stay includes
During a covered stay, Part A can pay for a semi-private room, meals, skilled nursing, physical and other therapies, medications, supplies, equipment and related services required for the skilled treatment plan. Coverage continues only while the person still meets Medicare’s medical and other coverage conditions; reaching day 100 ends the Part A SNF benefit for that benefit period even if the resident remains in the facility.
What counts as custodial care
Help with bathing, dressing, eating, toileting, transferring and other activities of daily living is generally custodial care when no daily skilled-care need exists. Medicare and Medigap generally do not pay for non-medical, long-term nursing-home care. Medicare’s own consumer guidance states: “Medicare generally doesn’t cover long-term care in a nursing home.”
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The following amounts apply to Original Medicare in 2026. The $1,736 Part A deductible is a benefit-period deductible; the daily figures apply to a covered SNF stay after that deductible.
| Covered SNF days in a benefit period | Original Medicare amount in 2026 | What the figure means |
|---|---|---|
| Days 1–20 | $0 per day | No daily SNF coinsurance after the $1,736 Part A deductible, provided all coverage requirements are met |
| Days 21–100 | $217 per day | Daily coinsurance for each covered day in this range |
| Day 101 and later | All costs | Original Medicare Part A provides no SNF benefit after 100 days in the benefit period |
The deductible and coinsurance are Medicare’s 2026 amounts and should be checked again for a later year. A Medicare Advantage plan may use different copayments, authorization rules and coverage conditions, so an enrollee must consult the plan’s current evidence of coverage rather than assume the Original Medicare schedule applies.
Why the 100-day limit matters
The limit is measured by Medicare benefit periods, not by a lifetime allotment. A new benefit period can become available after the person has been out of an inpatient hospital or SNF for the required period under Medicare rules. A new period does not remove the need for another qualifying stay and ongoing daily skilled-care eligibility. Ask the facility or Medicare plan to document the current benefit-period day count in writing.
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What Medicaid pays for long-term nursing-facility care
Medicaid’s institutional benefit is designed for residents who need nursing-facility care and cannot reasonably pay the full cost under the state’s rules. The facility must participate in Medicaid. Federal requirements make nursing-facility services available to eligible people age 21 and older who meet the state’s nursing-facility level-of-care criteria.
Services included in the institutional benefit
The covered package generally includes nursing or related services, specialized rehabilitation, medical social services, pharmaceutical services, dietary services, room and bed maintenance and routine personal-hygiene items required by federal standards. States define the details of the institutional rate and the billing rules within federal requirements.
Charges Medicaid may not cover
A facility may charge for permitted extras, such as a private room chosen for convenience rather than medical necessity, telephone, television, clothing or personal-comfort items. Ask for the facility’s written list of resident charges. Medicaid payment of the institutional rate does not automatically make every optional service free.
How Medicaid eligibility and resident payment work
There is no national Medicaid income limit, asset limit or resident-payment amount that can be applied to every nursing-home resident. Each state sets detailed financial standards and procedures within federal rules. Institutional Medicaid calculations can differ from the rules used for other Medicaid categories, and some states use higher financial limits for people residing in an institution.
The medical eligibility decision
The state Medicaid agency or its designated assessor determines whether the person meets the state’s nursing-facility level-of-care standard. A diagnosis alone is not enough; the assessment considers the intensity and frequency of nursing, rehabilitation, behavioral or assistance needs required in a nursing facility.
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The application typically reviews income, bank and investment accounts, real estate and other countable resources, along with ownership and transfer history. Rules differ by state and by whether the applicant is single or married. Do not assume that being unable to pay the private rate automatically establishes eligibility.
Post-eligibility income contribution
After approval, Medicaid generally requires the resident’s available income to be applied toward the cost of care. The calculation normally protects certain deductions before the facility receives the patient-pay amount:
- A personal-needs allowance for items such as clothing, toiletries and small personal expenses.
- An allowance for a spouse living in the community when spousal-impoverishment rules apply.
- Allowances for qualifying family members in appropriate circumstances.
- Specified medical expenses that Medicaid permits as deductions.
The exact personal-needs amount, spousal allowance, family allowance, deductions and treatment of different income types are state specific. The facility should provide a written resident-liability calculation, and the Medicaid agency should explain how it arrived at the figure.
How much private nursing-home care costs before Medicaid
Medicaid.gov’s “Spousal Impoverishment” page displays a nursing-home cost range of $5,000 to $8,000 a month or more. That figure is a broad illustration, not a national rate or a guaranteed price for a particular state, facility or date. Obtain a current quote from the facility and ask what is included.
What happens after Medicare’s 100 days
When a resident exhausts Medicare’s covered SNF days, Original Medicare stops paying the SNF benefit. The resident may then pay privately, use long-term-care insurance if available, or apply for Medicaid if the person meets the state’s financial and medical rules.
Remaining in the same facility
The resident can generally remain in the same nursing home if it is Medicaid certified and the resident becomes eligible. If the facility does not participate in Medicaid, Medicaid cannot pay that facility’s nursing-facility rate; a transfer to a Medicaid-certified home may be necessary. Ask about Medicaid certification before choosing a facility, not after Medicare coverage is exhausted.
Applying before the benefit ends
Medicaid processing can require extensive financial records and a level-of-care assessment. Ask the facility’s Medicaid specialist when to file and which documents are needed while Medicare is still paying. Filing early does not guarantee approval, but it can reduce the risk of an unpaid gap or a rushed move.
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How Medicare and Medicaid coordinate
For a person enrolled in both programs, Medicare generally pays first for services it covers. Medicaid is the payer of last resort. It may pay approved Medicare cost sharing or services Medicare excludes, subject to the person’s Medicaid category and state rules.
Examples include Medicaid payment for nursing-facility care after Medicare’s 100-day SNF limit, when the resident is eligible, and assistance with Medicare premiums and cost sharing for people who qualify for a full-benefit or other Medicare Savings category. Medicaid does not automatically pay every Medicare bill or every facility charge; the service must be covered under the applicable program and the provider must follow its participation rules.
Estate recovery and spousal protections
For Medicaid beneficiaries age 55 or older, states generally must seek recovery from the estate for nursing-facility services, home- and community-based services and related hospital and prescription-drug services. Recovery usually occurs after death, but state procedures and the definition of the recoverable estate vary.
Federal protections restrict recovery when a surviving spouse, a child under 21, or a blind or disabled child of any age remains. States must also provide hardship-waiver procedures. During permanent institutionalization, a state may place a lien on certain property, subject to statutory exceptions.
Estate recovery is not a reason to hide assets or transfer a home informally. Before selling, gifting or retitling property, obtain advice from an elder-law or public-benefits professional who understands the state’s Medicaid transfer-penalty, lien and recovery rules. A transfer that appears to preserve an inheritance can instead create a period of Medicaid ineligibility or a tax and ownership problem.
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- Identify the care category. Ask the treating clinician and the facility whether the current plan requires daily skilled nursing or rehabilitation, or whether the need is primarily custodial assistance.
- Confirm the hospitalization facts. Request the hospital’s inpatient versus observation classification, the number of qualifying consecutive inpatient days and the SNF admission date.
- Verify certification. Ask whether the facility is certified by Medicare, Medicaid or both. Get the answer in writing if long-term residence is likely.
- Get a benefit-period accounting. Ask Medicare or the Medicare Advantage plan for the number of SNF days used and the expected date of any coverage change.
- Request a written cost estimate. Have the facility separate Medicare coinsurance, Medicaid patient-pay liability, private charges and optional items.
- Start the Medicaid process early. Contact the state Medicaid agency and the facility’s admissions or benefits office for the application, level-of-care assessment and financial-document checklist.
- Protect a community spouse correctly. Ask about spousal-impoverishment allowances before moving accounts, selling a home or changing ownership. Informal transfers can trigger penalties.
- Discuss estate recovery. Obtain state-specific advice about liens, recovery, surviving-family protections and hardship waivers before making property decisions.
Common mistakes and how to avoid them
Assuming a three-day hospital visit qualifies
Observation time is not inpatient time for the three-day Medicare SNF requirement. Ask the hospital to clarify the admission status rather than relying on the number of nights spent in a bed.
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Confusing rehabilitation with unlimited coverage
A therapy appointment or rehabilitation diagnosis does not guarantee 100 covered days. Medicare requires continuing medical necessity and daily skilled care, and the benefit period still ends at day 100.
Waiting until day 100 to ask about Medicaid
Medicaid eligibility involves financial verification and a state level-of-care decision. Delaying the application can leave the family responsible for private charges while records are assembled.
Choosing a nonparticipating facility
A facility that accepts Medicare may not accept Medicaid. Confirm both certifications if the resident may need long-term coverage.
Promising that Medicaid will pay the entire bill
Medicaid usually requires a resident contribution from available income, and optional services can remain chargeable. Read the admission agreement and patient-pay notice carefully.
Using another state’s numbers
Income limits, resource rules, personal-needs allowances, spousal allowances, patient-pay formulas and estate-recovery procedures vary by state and can change. Use the current state Medicaid agency rules for the resident’s state, not an online figure from another jurisdiction.
Examples of how coverage can change
Short recovery followed by discharge
A beneficiary has a qualifying inpatient stay, enters a Medicare-certified SNF and needs daily skilled therapy. Medicare pays the covered SNF days under the 2026 schedule. If the person improves and returns home before day 100, Medicare’s SNF episode ends when coverage requirements are no longer met; it does not convert into long-term custodial coverage.
Medicare days exhausted, Medicaid approved
A resident remains in a Medicaid-certified facility after exhausting the 100-day Medicare benefit. Once the resident meets the state’s financial and level-of-care requirements, Medicaid can pay the institutional rate. The resident contributes the calculated patient-pay amount after protected deductions, and permitted extras may still be billed separately.
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If the state finds excess countable resources or an incomplete level-of-care record, Medicaid may deny or delay coverage. Request the written reason, correct missing documentation and use the state appeal process by its deadline. Do not give away assets to meet a limit without professional advice; transfers can cause a penalty period.
Quick Recap
Questions to ask before signing a nursing-home agreement
- Is this facility certified for both Medicare and Medicaid?
- Which services are included in the daily rate, and which are optional charges?
- What is the current private-pay rate, and how often can it change?
- How will the facility notify the family about Medicare coverage ending?
- When should a Medicaid application be filed, and who will help assemble records?
- How will the resident’s personal-needs allowance and patient-pay amount be calculated?
- What happens if Medicaid is denied, the resident’s income changes or the facility loses certification?
- What state estate-recovery and spousal-protection rules apply to this household?
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