Does Medicare cover a nursing home?

Only as short-term rehabilitation after a qualifying hospital stay: up to 100 days per benefit period, with coinsurance from day 21, ending as soon as skilled care is no longer needed. Living in a nursing home long term is custodial care, and Medicare covers none of it. The two happen in the same building, which is why people believe they are covered.

Who does pay for long-term care, then?

For most households the sequence is savings and income first, a long-term-care policy if one exists, then Medicaid once assets have been spent down to the state limit. Veterans and surviving spouses may reach a VA Aid and Attendance payment alongside any of those.

Does Medicaid pay for assisted living?

In some states, through a home and community-based waiver, usually with a waiting list and almost never covering room and board. This varies between states more than anything else on the page, so the state Medicaid agency is the only place that can answer it for you.

Should I buy long-term-care insurance?

This page will not tell you, and it names no insurer. Whether a policy is worth buying depends on your assets, your health and your family, and anyone answering that without knowing all three is selling something. What the page does say is what such policies typically cover and what triggers them.

Who Pays for What: Medicare, Medicaid, the VA, Insurance, and You

Six care situations against the five payers that actually exist, with a plain verdict in every cell. The short version is that Medicare covers skilled care and not the custodial help most people eventually need, which is why one column is almost entirely empty and why so many households are caught out.

Works offline — your inputs never leave this device. How that works

The distinction the whole page turns on

Medicare pays for skilled care — treatment by a clinician for something that can improve. It does not pay for custodial care, which means help with bathing, dressing, eating, moving and remembering. That line has nothing to do with where the care happens or how badly it is needed, and it is why the Medicare column below is mostly empty even though every row is real care that real people need.

Six situations, five payers

Open the row that matches your situation. Each cell says what that payer typically does and what it depends on — none of it is a determination, and every one of these payers decides its own cases.

MedicareUsually pays
This is what Part A is for. You pay a deductible per benefit period, and coinsurance begins after day 60. Note that being kept "under observation" is outpatient care, billed under Part B, and it does not count toward the three-day stay some later benefits require.
Medicaid (long-term care)Sometimes, with conditions
Pays for people who qualify, and can cover Medicare cost-sharing for those on both.
VA (Aid and Attendance)Does not pay
Aid and Attendance is a pension supplement, not health coverage. VA health care is a separate system.
Long-term-care insuranceDoes not pay
These policies cover long-term care, not acute medical treatment.
Your own moneySometimes, with conditions
The deductible and coinsurance, unless a supplement or another payer covers them.
MedicareSometimes, with conditions
Up to 100 days per benefit period, and only after a qualifying inpatient hospital stay: full coverage for the first 20 days, then daily coinsurance to day 100. Coverage ends when skilled care is no longer needed, which is often well before day 100 and comes as a shock.
Medicaid (long-term care)Sometimes, with conditions
Covers nursing-facility care for those who meet the state income and asset limits.
VA (Aid and Attendance)Does not pay
Not through Aid and Attendance, though the payment itself can be spent on care.
Long-term-care insuranceSometimes, with conditions
Depends on the policy: most require an elimination period first.
Your own moneySometimes, with conditions
The daily coinsurance from day 21, and everything after day 100.
MedicareDoes not pay
Nothing. This is custodial care, and Medicare does not cover it at any point. The 100 days above are rehabilitation after a hospital stay, which is a different thing that happens in the same building — which is exactly why people believe they are covered.
Medicaid (long-term care)Usually pays
The main public payer for long-term nursing-home care in the United States, once assets have been spent down to the state limit. Applying triggers a look-back at transfers.
VA (Aid and Attendance)Sometimes, with conditions
The monthly payment helps toward the cost for those who qualify. It does not cover it.
Long-term-care insuranceUsually pays
What these policies are principally designed for, subject to the trigger and daily limit.
Your own moneyUsually pays
Until savings reach the Medicaid limit, this is where the money comes from.
MedicareDoes not pay
Nothing toward the rent or the personal care, which is what assisted living charges for. If a doctor orders skilled care that happens to be delivered while you live there, Medicare may cover that service — but never the residence itself.
Medicaid (long-term care)Sometimes, with conditions
Some states cover services in assisted living through a home and community-based waiver, usually with a waiting list, and almost never the room and board. This varies more between states than anything else on this page.
VA (Aid and Attendance)Sometimes, with conditions
The Aid and Attendance payment can be spent on it, and the cost reduces countable income.
Long-term-care insuranceSometimes, with conditions
Many policies cover it; older policies sometimes cover nursing homes only.
Your own moneyUsually pays
The main payer for most households, at the state medians on this site.
MedicareDoes not pay
Not for help with daily living. Medicare home health is a separate, clinical benefit: intermittent skilled nursing or therapy, ordered by a doctor, for someone largely confined to home. It does not cover an aide coming in so somebody can stay at home.
Medicaid (long-term care)Sometimes, with conditions
Home and community-based waivers cover this in most states, subject to eligibility and waiting lists.
VA (Aid and Attendance)Sometimes, with conditions
The payment can be spent on it, and the cost reduces countable income for the income test.
Long-term-care insuranceSometimes, with conditions
Most modern policies cover home care; the hours and the daily limit are set by the policy.
Your own moneyUsually pays
Usually the payer, and the hours chosen move the cost more than the hourly rate does.
MedicareDoes not pay
Nothing. Medicare does not pay family caregivers in any circumstance.
Medicaid (long-term care)Sometimes, with conditions
Some states pay a family caregiver through a self-directed waiver, and a few allow a spouse. The rules and the rates are set state by state; the state Medicaid agency is the only place that can answer it.
VA (Aid and Attendance)Sometimes, with conditions
VA runs a separate caregiver support program with its own eligibility, distinct from Aid and Attendance.
Long-term-care insuranceSometimes, with conditions
A minority of policies pay a family caregiver; most require a licensed agency.
Your own moneyUsually pays
Almost always, and the real cost is the caregiver's own lost earnings and retirement contributions. It is the largest uncounted number in this whole subject.

Why the sequence usually runs the same way

For most households it is savings and income first, then a long-term-care policy if one exists, then Medicaid once assets reach the state limit. Veterans and surviving spouses may reach an Aid and Attendance payment alongside any of those. The order matters because Medicaid looks back at transfers made before an application — so the planning that helps has to happen years before the care is needed.

What this page will not do

It names no insurer and recommends no policy, including long-term-care insurance. Whether one is worth buying depends on your assets, your health and your family, and anyone who answers that question for you without knowing all three is selling something. The row above says what such a policy typically covers and what triggers it, and stops there.

Who to ask next

We publish figures and explain how they work. We do not decide anything, and nobody who does is on this website. These are the people who can, and the first four cost nothing.

Eldercare Locator — 1-800-677-1116 ↗Free
Run by the federal Administration for Community Living. Give them a ZIP code and they connect you to the area agency on aging that covers it, which is the office that knows what exists locally.
Your State Health Insurance Assistance Program ↗Free
One-to-one counseling on Medicare, Medicare Savings Programs and Extra Help, from someone paid by a federal grant rather than by commission. The local name differs by state — HICAP in California, SHINE in Florida, SHIBA in Washington.
Medicaid.gov — eligibility policy ↗Free
The federal rules Medicaid long-term care sits inside. Your own state agency administers them and is the only body that can decide your case.
VA — find an accredited representative ↗Free
VA's own search for accredited Veterans Service Organization representatives, attorneys and claims agents. VSO representatives help with pension and Aid and Attendance claims at no charge.
National Academy of Elder Law Attorneys ↗Directory is free; the attorney is not
Where to find a lawyer who does this work full time, if a transfer, a trust, a house or a second marriage is involved. Attorneys charge; asking one before you move money is usually cheaper than asking one afterwards.

Our own who to ask page sorts these by situation, and the paying for care hub holds the rest of this wing.

Estimate only — not financial, tax, legal, or insurance advice. Only MEDICARE can determine your actual amounts.

Official source: Medicare.gov — Long-term care ↗

🎓 Understand this tool

What it is

A matrix of six care situations against the five payers that actually exist — Medicare, Medicaid, the VA, a long-term-care policy, and your own money — with a plain verdict in every cell and the condition it depends on beside it.

How it works

Every verdict rests on one distinction that runs through the whole subject: Medicare covers SKILLED care, meaning treatment by a clinician for something that can improve, and does not cover CUSTODIAL care, meaning help with bathing, dressing, eating, moving and remembering. That line has nothing to do with the building the care happens in or how badly it is needed, which is why rehabilitation and long-term residence in the same nursing home are treated completely differently.

Getting the most from it

Find the row that matches the situation in front of you rather than the one you expect to need eventually. The answers differ sharply between them.
Read the Medicare cell first, because it is the assumption most likely to be wrong and the one most plans are quietly built on.
Read the Medicaid cell second, and note where it says the answer is set state by state — assisted living and paid family caregiving both vary enormously.
If there is a veteran or a surviving spouse in the household, read the VA row: the income test subtracts what you pay for care, which is what most people miss.
Take the state-specific parts to the state Medicaid agency or a SHIP counselor. This page can tell you which questions have a state answer; it cannot tell you what your state answers.

Reading your result

A cell marked as not paying is a statement about the program, not about your circumstances. A cell marked as sometimes paying is where the real work is: those are the ones with conditions, waiting lists, or state variation behind them, and they are worth a phone call rather than an assumption in either direction.

What it can't tell you

It carries no dollar figures at all — the costs live on the care-cost pages and the eligibility limits on the state Medicaid pages. It cannot tell you whether YOU qualify for anything, because every payer here decides its own cases. And it deliberately will not tell you whether to buy long-term-care insurance, which depends on assets, health and family that a web page cannot see.

Frequently asked questions

No. It pays nothing toward the rent or the personal care that assisted living charges for. If a doctor orders skilled care that happens to be delivered while you live there, Medicare may cover that particular service — but never the residence itself. Assisted living is paid for privately, by a long-term-care policy, or in some states through a Medicaid waiver.

Part of: Paying for Care: What It Costs and Who Actually Pays →

Related calculators

Care Costs

What in-home care, adult day programs, assisted living and nursing homes cost in your state, converted to monthly and yearly figures from the hours you actually expect to use. The survey publishes each kind of care in a different unit, so the arithmetic that makes them comparable is ours, and it is printed beside every number. Estimate only.

Look-Back

Medicaid examines a five-year window before an application, looking for gifts and property transfers, and one found there creates a penalty period that starts only once the money has already run out. Here is how that works, how fast a spend-down happens, and a printable worksheet. Not legal advice — your state agency decides.

Aid and Attendance

Aid and Attendance is paid as the gap between a maximum yearly pension rate and your income for VA purposes — and unreimbursed medical expenses above five percent of that rate come off your income first. This estimate shows both figures, so you can see why people in assisted living qualify. Not legal advice; accredited representatives help free.

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