Does Medicare pay for nursing home care in 2026? The 100-day SNF rule and what comes after

Recent updates

• October 2025 — The FY 2026 SNF Prospective Payment System (PPS) final rule took effect (federal fiscal year runs October 1 to September 30). Agency payment rates and Patient-Driven Payment Model (PDPM) adjustments changed; patient cost-sharing structure did not.

• 2026 daily coinsurance for SNF days 21–100 is $217 per day, per the CMS 2026 Medicare cost-sharing announcement.

Short answer

Medicare covers up to 100 days of skilled nursing facility (SNF) care per benefit period after a qualifying inpatient hospital stay. Medicare does not cover long-term custodial nursing home care. You need a 3-day inpatient hospital stay (observation does not count) and a daily skilled nursing or therapy need. Days 1 through 20 are fully covered; days 21 through 100 carry a daily coinsurance of $217 in 2026; after day 100, Medicare pays $0. Long-term nursing home care is typically paid by Medicaid, long-term care insurance, veteran benefits, or out of pocket.

SNF vs nursing home vs assisted living: what Medicare actually covers

Three terms often used interchangeably mean very different things under Medicare.

Many nursing homes have both a SNF wing (short-term rehab after hospitalization) and long-term custodial residents. The Medicare 100-day benefit applies only to the SNF-level stay.

The 100-day SNF rule explained

Medicare’s SNF benefit has four qualifying conditions.

• A 3-day inpatient hospital stay immediately before SNF admission. Observation status does not count — even if you were in a hospital bed for three days, if you were classified as observation rather than inpatient, you do not qualify. Ask the hospital case manager to confirm your status in writing.

• Admission to a Medicare-certified SNF within 30 days of hospital discharge.

• A daily skilled care need — skilled nursing (wound care, IV therapy, complex medication management) or skilled therapy (physical, occupational, or speech). Custodial help alone — non-skilled personal-care assistance such as help with bathing, dressing, toileting, transferring, meals, or supervision, without a daily skilled nursing or therapy need — does not qualify for the Medicare SNF benefit.

• A doctor or other allowed healthcare provider certifies your need and orders the SNF stay.

Coverage begins on day of admission and runs for up to 100 days per benefit period.

A benefit period starts on the day you are admitted to a hospital or SNF and ends after you have been out of a hospital or SNF for 60 consecutive days. There is no lifetime cap — a new benefit period can start after that 60-day break, restoring another 100 days of SNF coverage.

How much does Medicare pay for nursing home care?

Here is the 2026 cost breakdown, day by day, for SNF care that Medicare covers.

• Days 1–20: $0 patient coinsurance. Medicare pays fully.

• Days 21–100: $217 per day patient coinsurance. Medicare pays the rest.

• After day 100 in a benefit period: Medicare pays $0. You are responsible for the full cost of continued nursing home care.

For long-term custodial nursing home care that Medicare does not cover, private-pay costs vary widely by region, facility, and level of care.

Medigap (Medicare Supplement) plans may cover the days 21–100 coinsurance, depending on the plan. Medigap does not extend coverage beyond day 100 or cover long-term custodial care.

How long will Medicare pay for nursing home care?

The 100-day figure causes the most confusion, so it is worth stating carefully.

• 100 days per benefit period, not per calendar year, not per lifetime.

• A benefit period ends after 60 consecutive days out of a hospital or SNF. After that, a new benefit period can start, restoring a new 100-day allotment.

• Medicare can also stop before day 100 if the patient no longer needs daily skilled care — for example, if therapy goals have plateaued and the patient’s condition has stabilized. In that case, the SNF’s case management team will help families navigate a discharge when it is deemed safe and medically indicated. A Baba advocate can also be involved in this process to review the discharge plan, coordinate next steps, and evaluate appeal options if the family disagrees.

If your skilled care need continues but Medicare terminates coverage because the SNF or a plan says you have “plateaued,” you have the right to appeal (see below).

What happens when Medicare stops paying for nursing home care?

This is the moment most families are unprepared for. It happens either at day 100 or earlier if the SNF determines that skilled care is no longer needed.

The Notice of Medicare Non-Coverage (NOMNC). The SNF must give you a written NOMNC at least 2 days before Medicare coverage ends. This notice explains the reason and lists the phone number of the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for your state.

Your right to an expedited appeal. If you disagree with the coverage termination, call the QIO by noon of the day after you receive the NOMNC. The QIO decides within 72 hours. Medicare continues to pay during the review.

Post-Medicare coverage paths:

• Medicaid is the primary long-term nursing home payer in the United States. Eligibility is based on income and assets and varies significantly by state. Many families reach Medicaid eligibility through a “spend-down” process, using savings and assets to cover care until they qualify. Applying takes time — start early if long-term care looks likely.

• Long-term care insurance pays if the patient had a policy in place before the need arose. Check the policy for elimination periods and benefit limits.

• Veteran benefits — Aid and Attendance for eligible veterans, or admission to a VA Community Living Center. Contact the VA directly.

• Private pay — savings, family contributions, life insurance conversions, reverse mortgages, annuities. Financial planning matters.

• Medicare Advantage supplemental benefits — some MA plans include limited in-home or custodial care support, depending on the plan; verify with the specific plan.

How to get into a nursing home on Medicare

The process is usually initiated by the hospital discharge team.

• Confirm your inpatient status. Ask the case manager whether you have been classified as inpatient for at least 3 days. If you are on observation status, request a status change if clinically appropriate.

• The hospital discharge planner identifies SNF options. You have the right to choose from Medicare-certified facilities in your area. Search at medicare.gov/care-compare for star ratings and inspection reports.

• Ensure the SNF is Medicare-certified for your service area. Some facilities have both Medicare and Medicaid certification; others only one. This matters for post-100-day transitions.

• The certifying practitioner (a physician or other allowed healthcare provider) orders the SNF stay with documentation of skilled care need.

• Admission paperwork at the SNF includes acknowledgment of your rights (Medicare Beneficiary Notice, resident rights under the Nursing Home Reform Act).

• Care planning meeting typically within the first week. Attend if possible, and bring a family member or advocate.

For a broader guide to the hospital discharge process itself, see Baba’s hospital discharge planning guide.

Medicare Advantage and nursing home coverage

Medicare Advantage plans must offer at least the same SNF benefit as Original Medicare, but the process differs.

• Some MA plans waive the 3-day inpatient hospital stay requirement, depending on the plan. This can be helpful if you are being admitted directly from home or from an observation stay. Check your plan’s Evidence of Coverage.

• Prior authorization may be required, depending on the plan. The plan may require approval before SNF admission and periodically during the stay.

• Network restrictions. MA plans may require use of in-network SNFs.

If your MA plan denies SNF coverage, appeal through the plan’s expedited appeals process. See Baba’s guide to appealing a prior authorization denial.

How Medicare and Medicaid work together for long-term nursing home care

Many nursing home residents are “dual-eligible” — enrolled in both Medicare and Medicaid.

• Medicare pays first for the SNF-level care (up to 100 days per benefit period).

• Medicaid picks up after Medicare stops paying, if the patient qualifies financially.

• Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans specifically designed for dual-eligible individuals, coordinating both benefits.

• The PACE program (Program of All-Inclusive Care for the Elderly) provides comprehensive care in the community for dual-eligible seniors who would otherwise need nursing home level of care. Availability varies by area.

Applying for Medicaid nursing home coverage takes time — often weeks to months. If a family member is in a SNF and reaching day 60 or 70, start the Medicaid application immediately.

Special cases: dementia patients in nursing homes

Medicare’s SNF coverage rules apply the same way for patients with dementia. The skilled care requirement is where dementia cases often need attention.

• Skilled needs that can qualify include medication management for complex regimens, wound care, physical or occupational therapy after a fall or hospitalization, and behavioral care that requires nursing supervision.

• Long-term memory care and custodial dementia care are not typically Medicare-covered. These are usually Medicaid (in states with strong nursing home Medicaid coverage), long-term care insurance, or private pay.

Families of people with dementia should plan for the transition from Medicare SNF coverage to Medicaid or long-term care insurance early — before the 100 days run out.

What to do if Medicare denies SNF coverage

Common denial reasons:

• The 3-day inpatient hospital stay requirement was not met (often because time was in observation status).

• The skilled care requirement is not clearly documented.

• The SNF terminates coverage citing a “plateau” in progress.

Your appeal rights:

• On termination during a SNF stay: the NOMNC gives you the right to an expedited QIO appeal, decided within 72 hours.

• On applicable Original Medicare initial denials: file a redetermination with the Medicare Administrative Contractor within 120 days. For Medicare Advantage, follow the plan’s appeals process.

For the full appeal ladder, see Baba’s guide to appealing a Medicare denial.

How Baba helps

A Baba advocate helps you and your family navigate Medicare’s SNF benefit and the transition to long-term care. Medicare may cover some care navigation and coordination services when specific eligibility, practitioner, consent, and supervision requirements are met. Talk to Baba to see whether you qualify. What that looks like:

• SNF eligibility screening. Your advocate confirms your inpatient status, the 3-day requirement, and the skilled care documentation before admission.

• Benefit-period tracking. Your advocate tracks day counts and flags approaching day 20 and day 100 milestones so nothing catches you by surprise.

• Medicaid transition planning. If long-term care looks likely, your advocate helps you start the Medicaid application in time.

• Discharge coordination. If the SNF’s case management team is preparing a discharge because Medicare coverage is ending, your advocate reviews the plan with you, helps evaluate whether it is safe and medically indicated, and coordinates next steps.

• Denial and appeals support. If the SNF or a Medicare Advantage plan terminates coverage, your advocate helps file the QIO appeal.

• Facility selection. Your advocate uses medicare.gov/care-compare to compare Medicare-certified nursing homes on quality ratings and inspection history.

• Care planning meeting support. Your advocate attends the SNF care planning meeting and helps make sure the plan meets the patient’s needs.