Nursing home insurance calculator: who pays, and how much is left for you
Pick a state and a care type, add the skilled days Medicare might cover and your own long-term care policy, and see the bill split three ways — Medicare, insurance, and you. The cost side uses 2025 state medians; the Medicare side uses the 2026 Part A amounts.
Data: CareScout Cost of Care Survey — 2025 national medians
Cost: CareScout Cost of Care Survey 2025, state medians. Medicare: medicare.gov skilled nursing facility coverage, 2026 amounts verified 2026-11-02. Medicaid is not modelled — state rules differ.
Nursing home — semi-private room · Georgia
$8,821 / month
365 days of care ≈ $105,852 total, at $290/day (2025 state median, extrapolated by 365 days ÷ 12 months).
Medicare pays 30 skilled days here; LTC insurance pays for 275 days after the elimination period.
Where the money goes, by Medicare band
| Band | Days | Cost | Medicare | LTC | You |
|---|---|---|---|---|---|
| Days 1–20 | 20 | $5,800 | $4,064 | $0 | $1,736 |
| Days 21–100 | 80 | $23,200 | $730 | $1,500 | $20,970 |
| Day 101 and beyond | 265 | $76,851 | $0 | $39,750 | $37,101 |
What this model does not decide
Modelled as 30 skilled days inside the 100-day Part A limit. Observation or emergency-room time does not count toward the 3-day qualifying stay.
If savings run out, Medicaid is the payer of last resort, but eligibility is decided by your state's income and asset rules — not something this calculator can decide.
The three payers, in the order they actually apply
1. Medicare Part A
Short-term, skilled only. $1,736 deductible per benefit period, then $0/day for days 1–20 and $217/day for days 21–100. Nothing after day 100. Requires a 3-day qualifying inpatient stay and a daily skilled need.
2. Long-term care insurance
Policy-specific: a daily or monthly benefit, an elimination period you pay yourself, and a benefit period measured in months or years. It pays for custodial care — which Medicare does not — but only after the elimination period and only up to the cap.
3. Medicaid
The payer of last resort, and the largest payer of long-term nursing home care in the United States. Income and asset limits, covered settings and payment rates are all set by the state — which is why this calculator does not put a number on it.
What the split usually looks like
Three patterns repeat across most families, and the calculator is built to show all three rather than one headline number:
- A short skilled stay after a hospital admission. Medicare carries most of the first 20 days, a copay carries days 21–100, and the family pays a small fraction. This is the case Medicare was designed for.
- A long custodial stay. Medicare pays nothing because there is no skilled need, a long-term care policy pays its daily benefit after the elimination period, and the gap is the family's. This is where savings disappear.
- A stay that outlives the policy. Once the benefit period is used up the insurance bar stops mid-stay, no matter how many months remain. Try the same inputs with a 12-month and a 36-month benefit period and watch where the bar ends.
Before you rely on any of it
Three checks worth doing while the numbers are still hypothetical: confirm the policy's benefit trigger (many require help with two of six activities of daily living or a cognitive impairment), confirm whether it reimburses expenses or pays a flat daily amount, and confirm the elimination period is measured in calendar days or service days — the same 90-day policy can mean two very different things. The cost calculator covers the price side across five care types, and the nursing home cost data shows the state medians behind this page.
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Frequently asked questions
Frequently asked questions
Does Medicare pay for nursing home care?
Only for skilled care, and only for a limited time. In 2026 you pay $0 per day for days 1–20 after the $1,736 Part A deductible, $217 per day for days 21–100, and all costs from day 101. Part A limits skilled nursing facility coverage to 100 days in each benefit period, and care must follow a qualifying 3-day inpatient hospital stay with a daily skilled need.
Why does the calculator ask how many days of skilled care qualify?
Because that number, not the length of the stay, is what Medicare pays on. A 12-month nursing home stay can have 100 skilled days and 265 custodial days — Medicare covers part of the first group and nothing at all of the second. If you enter 0 skilled days the Medicare bar shows zero, which is the honest answer for a custodial admission.
Does time in the emergency room or under observation count toward the 3-day stay?
No. Medicare's own guidance is explicit that time spent in the hospital under observation, or in the emergency room before admission, does not count toward the 3-day qualifying inpatient hospital stay, even if you were there overnight. This is one of the most common reasons a skilled nursing stay is denied at the billing stage.
How is the long-term care insurance part calculated?
Daily benefit × days after the elimination period, capped by the benefit period, and capped again by what is still unpaid on that day. A $150 daily benefit with a 90-day elimination period and a 36-month benefit period pays 90 fewer days than the same policy with no elimination period. Real policies vary: some reimburse actual expenses, some pay a flat indemnity, and some count the elimination period in service days rather than calendar days — so treat the LTC bar as an illustration, not a policy quote.
What does Medicaid cover, and why is it zero in this calculator?
Medicaid is the largest payer of long-term nursing home care in the United States, but eligibility is decided by each state's income and asset rules, and payment rates differ by state and by facility. Rather than invent a state formula, this calculator keeps Medicaid at $0 and says so. If you are already approved, the number that matters is your state's rules — start with the Medicaid guides on this site.
Is the cost figure a quote?
No. It is the 2025 CareScout Cost of Care Survey median for that state and that care type, converted to a daily rate at 365 days per year. Local prices vary substantially around a state median, and the survey's own methodology warns against treating medians as prices. Use it to size the gap, then get real quotes.