Paying for care
Who pays for nursing home care — Medicare or Medicaid?
Both do, at different points in the same stay, and the order is fixed. Medicare pays first, for short-term skilled care or rehabilitation after a qualifying hospital stay, for a limited number of days. When that ends the person pays privately. Medicaid enters last, once the person meets the state's financial and level-of-care rules, and it is the one program of the two built for long-term care. Knowing which stage a stay has reached is most of the answer to which program pays.
Data: CareScout Cost of Care Survey — 2025 national medians
Data: CareScout Cost of Care Survey — 2025 national medians — fieldwork July–November 2025.
The comparison, side by side
The two programs are not competing plans. One is an insurance entitlement that pays for a defined service for a defined period. The other is a means-tested program that pays for long-term care, and it takes over where the insurance stops.
| Question | Medicare | Medicaid |
|---|---|---|
| What it pays for here | Daily skilled nursing care and therapy after a hospital stay | Long-term care in a Medicaid-certified nursing facility, including room and board |
| How long it lasts | Up to 100 days per benefit period, and only while skilled care is needed | For as long as the person remains eligible and needs the level of care |
| What qualifies a person | Part A, a qualifying inpatient hospital stay, and a medical need for daily skilled care | Income and resource limits set by the state, plus a state level-of-care determination |
| What the person pays | In 2026: the $1,736 Part A deductible, then $0 for days 1–20 and $217 a day for days 21–100 | Most income goes to the cost of care, minus allowances the state must set aside |
| When it applies | First, after the hospital | Last, when other payment options are unavailable |
Medicare amounts are the 2026 figures published by Medicare.gov. The order of payment is described in the government's own summary of the Medicaid nursing facility benefit.
How one stay moves between the two
Federal guidance describes the sequence directly, and it is worth following because it is the part families are usually asking about. A person is admitted to hospital. The stay qualifies them for a limited period of Medicare skilled nursing facility services. If nursing home care is still needed after that period of coverage runs out, the person pays privately and uses any long-term care insurance they hold. If those resources are exhausted and the person becomes eligible for Medicaid, and the facility is also Medicaid-certified, the person can carry on living there under the Medicaid nursing facility benefit.
Three things sit inside that sentence and decide most cases. The Medicare period is defined by days and by a continuing need for skilled care, not by a diagnosis. The private stretch is where the numbers on this site start to matter, because it is paid at the facility's own rate. And the Medicaid step requires two separate findings, one about money and one about the level of care the person needs.
The hospital stay that starts it
Medicare does not open a skilled nursing facility benefit without a hospital stay behind it. The requirement is a medically necessary inpatient hospital stay of at least three days in a row, counted from the day the person was admitted as an inpatient and not counting the day of discharge. The caution is that time under observation or in the emergency room before admission does not count toward those three days, even when it ran overnight. A person can therefore be in hospital for several nights and still not have the qualifying stay, because the nights were recorded as observation.
Two routes can set the three-day rule aside. A doctor who participates in an accountable care organisation approved for the skilled nursing facility three-day rule waiver can make the stay unnecessary, and a Medicare Advantage plan may also waive the three-day minimum. Both depend on the specific arrangement, which is why the practical advice on this point is to ask the hospital and the plan directly. The full eligibility conditions and the appeal route for a hospital that reclassified an inpatient stay as observation are set out in the skilled nursing coverage guide.
The handoff, and who pays next
Medicare coverage ends when the days run out or when the need for daily skilled care ends, whichever comes first. From that point the bill is private. The survey this site uses puts the 2025 national median for a semi-private nursing home room at $9,581 a month and a private room at $10,798. Long-term care insurance, if the person has it, is used here, and what it actually covers is worth checking before the change of payer rather than after.
Medicaid is designed to be the payer of last resort in this sequence. The government's summary of the benefit says nursing facility services are available only when other payment options are unavailable and the individual is eligible for the program. That means the application is not a parallel track to Medicare; it is the step after the private period. What a person applies for, and what counts toward the limits, is covered in the Medicaid nursing home guide, and how a spouse's share is protected is on the spousal impoverishment page.
Staying in the same building
A change of payer does not have to mean a change of address. Many nursing homes are certified as a Medicare skilled nursing facility and also accept long-term care insurance and private payment. When the payment source changes to Medicaid and the home is certified as a Medicaid nursing facility, the resident can usually stay where they are. If the home is not Medicaid-certified, the person would have to transfer to one that is.
That makes a single question worth asking before choosing a home: which programs is this building certified for, and is the bed covered if the payer changes. The facility's quality ratings are public, and checking them before arrangements are made is the advice the government gives on its own nursing home pages. The nursing home cost page goes through what a monthly rate includes and what it does not, and the care cost calculator turns the medians into a monthly figure for a particular situation.
The difference that changes the answer
Access works differently between the two programs, and the difference is not obvious from the eligibility rules. Nursing facility services are a required Medicaid benefit for people aged 21 or older who need them, and states may not limit access to the service or make it subject to waiting lists. Home and community-based services, by contrast, may be capped and queued, which is why a person who is eligible for help at home may still wait for it while an eligible person can enter a facility.
That is the practical argument for understanding this comparison in advance. A family that assumes both pathways behave the same can lose weeks. The government's own guidance also points in the other direction once someone is in a facility: residents and families are encouraged to keep looking at other long-term care options so the person can return to the community as soon as that is possible.
Three things this is not
- Not a choice between the two. Being on Medicare does not stop anyone from applying for Medicaid, and the two can cover the same person at different stages of the same stay. A person can also qualify for both at once.
- Not a single national Medicaid rule. The federal government requires the benefit; each state defines the level of care and sets the eligibility limits inside federal floors and ceilings. Some states also use higher eligibility limits for people who live in an institution.
- Not advice you can act on from an article. Which payer applies on a given day turns on clinical findings, a hospital record and a state determination made from documents. Anything worth acting on belongs with the facility's business office and the state Medicaid agency, not with a page about the rules.
Frequently asked questions
Is Medicare or Medicaid the one that pays for a nursing home?
Both can pay, for different parts of the same stay. Medicare pays for short-term skilled nursing care or rehabilitation after a qualifying hospital stay, for a limited period. Medicaid pays for long-term care in a nursing facility for people who meet the state's financial and level-of-care rules. The Centers for Medicare & Medicaid Services states the Medicaid nursing facility benefit is available only when other payment options are unavailable, which puts Medicaid last in line between the two.
How long does Medicare pay toward a nursing home stay?
Up to 100 days in a benefit period, and only while skilled care is medically necessary. In 2026, after the Part A deductible of $1,736, days one through 20 cost $0 and days 21 through 100 cost $217 a day. From day 101 the person pays all costs. The 100-day limit applies to the skilled nursing facility benefit, not to long-term care.
Does Medicare pay for long-term care at all?
No, not for custodial care when that is the only care needed. Medicare's own guidance is that it generally does not cover long-term nursing home stays unless the person is receiving skilled nursing care. Custodial care is help with daily activities such as bathing, dressing, eating and using the bathroom, and that is the bulk of what a long-term nursing home stay consists of.
What has to happen before Medicare pays for a nursing facility stay?
There has to be a medically necessary inpatient hospital stay of at least three days in a row, counted from the day of admission as an inpatient and not counting the day of discharge. Time spent under observation or in the emergency room before admission does not count toward those three days, even if it lasted overnight. The person then has to enter the facility within a short time, generally 30 days, and need daily skilled care.
Can the same building be both a Medicare facility and a Medicaid facility?
Often, yes. The government's own guidance says many nursing homes are certified as a Medicare skilled nursing facility and also accept long-term care insurance and private payment. In many cases it is not necessary to move when the payment source changes to Medicaid, provided the nursing home is also certified as a Medicaid nursing facility. If it is not, the person would have to transfer to one that is.
What happens at the end of the Medicare period?
If nursing home care is still needed, the person pays privately, using long-term care insurance if there is any. That is the stretch where the survey figures matter, at a 2025 national median of $9,581 a month for a semi-private room and $10,798 for a private room. If the person uses up the assets and becomes eligible for Medicaid, and the facility is Medicaid-certified, coverage can continue under the Medicaid nursing facility benefit.
Is there a waiting list for Medicaid nursing home care?
No. Nursing facility services are a required Medicaid benefit for people aged 21 or older who need them, and states may not limit access to the service or make it subject to waiting lists the way they may for home and community-based services. In some cases that makes facility care more immediately available than the alternatives, and the government's guidance encourages residents and families to look at other options so the person can move back to the community as soon as possible.
Can a person have Medicare and Medicaid at the same time?
Yes. They are separate programs with separate rules, and someone can qualify for both. Medicare works from an insurance entitlement and Medicaid from financial and level-of-care tests set by the state. Being on Medicare does not stop a person from applying for Medicaid, and running out of Medicare coverage is one of the reasons people do.
Where these rules come from
The Medicare side of this page comes from Medicare.gov: the skilled nursing facility page, which is the source of the qualifying hospital stay, the exclusion of observation and emergency room time, the requirement that the person enter the facility within generally 30 days, the need for daily skilled care, the waiver routes for accountable care organisations and Medicare Advantage plans, the benefit period, and the 2026 amounts of the $1,736 Part A deductible, $0 for days one through 20, $217 a day for days 21 through 100 and all costs from day 101. The same page and the nursing home coverage page are the source of the point that Medicare does not cover custodial care when that is the only care needed, and that its coverage of a nursing facility stay is short-term and tied to skilled care. The Medicaid side comes from the Medicaid nursing facilities page: the three service types a certified nursing facility provides, the requirement that the facility be licensed and certified by the state as a Medicaid nursing facility, the statement that services are available only when other payment options are unavailable and the person is eligible, the paragraph describing how one person moves from a Medicare skilled nursing facility stay to private payment to the Medicaid nursing facility benefit, the point that a change of payer usually does not require a move, the requirement that the benefit be provided for people aged 21 or older, and the rule that states may not limit access or apply waiting lists to it, unlike home and community-based services. Care costs are the national medians from the survey named at the top of this page. Nothing on this page is legal or financial advice.
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