Quick Answer
Medicare pays for short-term, skilled nursing care: up to 100 days per benefit period after a qualifying 3-day inpatient hospital stay ($0 for days 1–20, then $217/day for days 21–100 in 2026). Medicaid pays for long-term custodial nursing home care, but only after you meet strict income and asset limits ($2,982/month income and $2,000 in assets in most states for 2026). Many families use both: Medicare first, then Medicaid once savings run out. Use our free search tool to find facilities that accept Medicare, Medicaid, or both.
Table of Contents
What Medicare Covers: The 100-Day Benefit
Medicare Part A covers care in a skilled nursing facility (SNF) only when your loved one needs daily skilled care — services that must be performed or supervised by licensed professionals, such as IV medications, wound care, or physical therapy after a hip replacement. It is a rehabilitation benefit, not a long-term housing benefit.
Medicare SNF Costs in 2026 (per benefit period)
Days 1–20: $0
Medicare pays the full cost of covered SNF care. You pay nothing for the room, meals, nursing, and therapy.
Days 21–100: $217 per day
Per 2026 CMS figures, you owe a daily coinsurance of $217.00. Over the full 80 days that's $17,360 out of pocket — a Medigap (Medicare Supplement) policy or Medicare Advantage plan may cover some or all of it.
Day 101 and beyond: you pay everything
Medicare coverage ends completely. At the national median of $315/day for a semi-private room (CareScout 2025 Cost of Care Survey), that's roughly $9,581 per month.
Important: 100 days is the maximum, not a guarantee. Medicare only keeps paying while your loved one needs and receives daily skilled care and is making documented progress or needs skilled maintenance. Many stays end well before day 100 because the facility determines skilled care is no longer required. You have the right to a written notice and a fast appeal if you disagree.
What Medicare never covers in a nursing home: long-term custodial care — help with bathing, dressing, eating, toileting, and supervision for dementia — when no daily skilled service is needed. That care, which most long-term residents need, falls to Medicaid, long-term care insurance, VA benefits, or personal savings.
Benefit Periods and the 3-Day Inpatient Rule
Two technical rules trip up more families than any others:
The 3-day inpatient hospital stay rule
To qualify for Medicare SNF coverage, your loved one generally must first spend 3 consecutive days as a formally admitted hospital inpatient (not counting the discharge day). Time spent in the emergency room or under "observation status" does not count — even if it involved several nights in a hospital bed. Ask the hospital every day: "Is my parent admitted as an inpatient, or under observation?"
Our hospital discharge planning guide covers the observation-status trap and how to push back.
How benefit periods reset
The 100 days apply per benefit period, not per lifetime. A benefit period starts when your loved one is admitted as a hospital inpatient and ends after they have gone 60 consecutive days without any inpatient hospital or skilled nursing care. After that 60-day break, a new qualifying 3-day hospital stay starts a fresh 100-day benefit (and a new Part A deductible — $1,736 in 2026). There is no limit on the number of benefit periods.
What Medicaid Covers: Long-Term Care
Medicaid is the largest payer of nursing home care in the United States. Unlike Medicare, Medicaid covers long-term custodial care indefinitely — room, board, nursing care, personal care, medications, and therapies — for as long as your loved one medically needs nursing home level care and remains financially eligible.
The trade-offs: not every facility accepts Medicaid, Medicaid-certified facilities may have limited bed availability for Medicaid residents, and nearly all of your loved one's monthly income (minus a small personal needs allowance and certain deductions) goes toward the cost of care, with Medicaid paying the rest.
When searching, filter for facilities that accept Medicaid from the start — moving later is disruptive. Our facility search lets you filter by Medicaid acceptance, and your state's overview page lists local Medicaid program details.
Medicaid Eligibility: 2026 Income & Asset Limits
Medicaid is a joint federal-state program, so exact rules vary by state. These are the most common 2026 standards for nursing home (institutional) Medicaid:
Income limit: $2,982/month (2026, most states)
Most states cap a nursing home applicant's income at 300% of the SSI federal benefit rate — $2,982/month in 2026 (3 × $994). If income is slightly over, many states allow a Qualified Income Trust (Miller Trust) to still qualify. Other states use a "medically needy" pathway instead.
Asset limit: $2,000 (individual, most states)
Countable assets — savings, investments, extra property — must generally be at or below $2,000 for an individual (commonly $3,000 for a married couple when both apply). Exempt assets typically include the primary home (up to a state equity limit, when a spouse lives there or the resident intends to return), one vehicle, personal belongings, and prepaid funeral arrangements.
California exception: $130,000 asset limit
California eliminated its Medi-Cal asset test in 2024, then reinstated it at $130,000 per individual (plus $65,000 per additional household member) effective January 1, 2026 — 65 times the standard limit elsewhere. If your family is in California, see the California nursing homes page for state-specific details.
The 60-month look-back
When you apply, the state reviews 60 months (5 years) of financial records. Gifts or below-market transfers in that window create a penalty period during which Medicaid won't pay, calculated by dividing the transferred amount by the state's average monthly nursing home cost. California is the exception with no look-back. This is the main reason to consult an elder law attorney before moving money.
"Spending down" to these limits is legal and common — paying for care, paying off debt, making home modifications, or prepaying funeral expenses all reduce countable assets without penalty. Deliberately gifting assets to family within the look-back window is what triggers penalties.
Spousal Protections: The Healthy Spouse Is Not Left Broke
Federal "spousal impoverishment" rules protect the spouse who remains at home (the community spouse) when the other spouse enters a nursing home on Medicaid:
- ✓Community Spouse Resource Allowance (CSRA): In 2026, the at-home spouse may keep between $32,532 and $162,660 in countable assets (the exact amount depends on the state and the couple's total assets), on top of the exempt home and vehicle. Source: 2026 federal spousal impoverishment standards.
- ✓Monthly Maintenance Needs Allowance (MMNA): If the at-home spouse's own income is low, a portion of the nursing home spouse's income can be diverted to them — between roughly $2,643.75 (minimum, effective 7/1/25–6/30/26) and $4,066.50 (2026 maximum) per month.
- ✓The community spouse's own income is not counted toward the applicant's eligibility in most states.
These rules are complex and state-specific. A consultation with a certified elder law attorney (many offer free initial consultations) frequently preserves tens of thousands of dollars for the at-home spouse — entirely legally.
Dual Eligibility: Using Both Programs
Many nursing home residents are dual eligible — enrolled in both Medicare and Medicaid. This is the typical sequence:
- Hospital stay: Medicare Part A covers the qualifying inpatient stay.
- First 100 days in the SNF: Medicare pays (with the $217/day coinsurance after day 20 in 2026).
- Skilled care ends, custodial care continues: The family pays privately, spending down assets.
- Assets reach the state limit: Medicaid is approved and takes over the long-term cost. Medicare remains primary for doctor visits, hospitalizations, and any future skilled care; Medicaid covers premiums and most cost-sharing.
Because this transition is predictable, plan for it on day one: choose a facility that is both Medicare- and Medicaid-certified so your loved one won't have to move when the payer changes. Ask every facility directly: "If my parent transitions to Medicaid, can they stay in the same bed?"
Find Facilities That Accept Medicare and Medicaid
Use our free navigator to search thousands of certified facilities, filter by insurance acceptance, and compare quality scores built from official CMS data.
Start Free Facility Search →How to Apply
Medicare SNF coverage
There is no separate application. If your loved one has Medicare Part A, meets the 3-day inpatient rule, and is admitted to a Medicare-certified SNF within 30 days of leaving the hospital with a doctor's order for daily skilled care, coverage applies automatically. The hospital discharge planner and the SNF admissions office handle the paperwork — your job is to verify inpatient status and confirm the facility is Medicare-certified.
Medicaid long-term care
- Apply through your state Medicaid agency — online, by mail, or in person. Many nursing homes have staff who help families complete the application.
- Gather 5 years of financial records: bank statements, property deeds, life insurance policies, retirement accounts, and records of any gifts or transfers.
- Expect a level-of-care assessment confirming your loved one medically needs nursing home care.
- Plan for 45–90 days of processing. Apply before savings are exhausted — many facilities accept "Medicaid pending" residents, but confirm in writing.
- Consider professional help for anything beyond a simple case: elder law attorneys and your local Area Agency on Aging (free) can prevent costly mistakes.
Common Misconceptions
"Medicare will cover Mom's nursing home."
Only short-term skilled care, capped at 100 days per benefit period — and often less. Long-term custodial care is never covered by Medicare.
"We have to lose everything before Medicaid helps."
The home, a vehicle, and personal items are typically exempt, and spousal protections let the at-home spouse keep up to $162,660 in assets (2026) plus a monthly income allowance.
"Three nights in the hospital always qualifies for Medicare rehab."
Only formally admitted inpatient days count. Nights under observation status look identical from the bed but don't count toward the 3-day rule.
"It's too late to apply for Medicaid — we already gave money to the kids."
Transfers within the 60-month look-back cause a penalty period, not a permanent bar — and some transfers (to a spouse, a disabled child, or a caretaker child in certain cases) are exempt. Get professional advice before assuming you're disqualified.
"Medicaid facilities are lower quality."
Quality varies facility by facility, not by payer. Many 5-star facilities accept Medicaid. Compare inspection results and staffing with our comparison tool rather than assuming.
Related Guides
Note: This guide provides general information, not legal or financial advice. Medicare figures reflect CY 2026 CMS rates; Medicaid limits reflect 2026 federal standards and vary by state. Confirm current rules with Medicare.gov, your state Medicaid agency, or an elder law attorney before making decisions.