Whether Medicare covers skilled nursing, home health, or hospice usually gets decided at the worst possible moment, as a parent is discharged to rehab or a family faces a terminal diagnosis. Medicare does pay for all three, but each comes with its own eligibility rules, its own time limits, and its own out-of-pocket costs, and none of them covers the thing families most often assume they will: long-term custodial care. This guide walks through what Medicare pays for each benefit in 2026, for how long, and where the gaps are.

Medicare covers skilled nursing and therapy, not long-term custodial care

Before the details, here's the throughline that explains every rule below: Medicare pays for skilled and time-limited care, not for long-term custodial care.

Skilled care means services that legally require a licensed professional, a nurse, a physical therapist, a speech pathologist. Custodial care means help with the activities of daily living, bathing, dressing, eating, moving around, when that's the only help a person needs. It's the kind of care most people picture when they say "nursing home," and it's the single biggest thing Medicare does not pay for. The skilled-nursing, home-health, and hospice benefits all sit on the skilled side of that line. Once a person needs only custodial help, Medicare stops paying, and families turn to private pay, long-term care insurance, or Medicaid.

How the three benefits compare

Each benefit answers a different need, so the fastest way to see where you or your family member fits is side by side.

Skilled nursing facility Home health Hospice
What it's for Short-term rehab or skilled care after a hospital stay Skilled care at home for someone who is homebound Comfort care for a terminal illness
Medicare part Part A Part A and Part B Part A
Main eligibility test 3-day qualifying inpatient stay (waiver, 30-day re-entry, or appeal can substitute), then a daily skilled need Homebound plus an intermittent skilled need Doctors certify 6 months or less to live; you choose comfort over cure and sign an election statement
Time limit Up to 100 days per benefit period No fixed cap while you stay eligible Two 90-day periods, then unlimited 60-day periods
What you pay $0 days 1-20 after the Part A deductible; $217/day days 21-100; full cost after $0 for covered services; 20% on equipment after the Part B deductible Up to $5 per drug; 5% for respite care; room and board and unarranged care fall outside
Covers custodial care? No No No (comfort care, not long-term custodial)

Does Medicare cover skilled nursing facility care?

Skilled nursing facility care is the benefit families meet most often, usually when a parent finishes a hospital stay and isn't ready to go home. It covers short-term skilled care, the kind that needs a nurse or therapist, in a Medicare-certified facility. Here's how it works.

First, the 3-day rule. To qualify, you generally need a qualifying inpatient hospital stay of at least three consecutive days, you have to enter the SNF within a short time of leaving the hospital (generally 30 days), and the skilled care has to relate to the condition you were treated for. This is where one detail trips people up: only time admitted as an inpatient counts. If the hospital had you under observation status, even overnight, those days don't count toward the three, and that can quietly disqualify a stay. Confirm your status while you're still in the hospital, not after.

A missed three days is not the end of it. Four routes stay open, and it's worth working through all four before anyone pays privately:

  • A waiver. You may not need the 3-day minimum if your doctor participates in an Accountable Care Organization approved for a Skilled Nursing Facility 3-Day Rule Waiver, and a Medicare Advantage plan may also waive it. Ask the discharge planner which applies.
  • Re-entry within 30 days. If you leave a SNF and re-enter the same or another SNF within 30 days, you don't need a second qualifying hospital stay. The same is true if skilled care stops while you're in the SNF and starts again within 30 days.
  • An appeal of the status change. If a hospital admitted you as an inpatient and then switched you to "outpatient getting observation services," you can appeal, and if the appeal is approved Part A may cover both the hospital and the SNF care you got. There are two tracks, and which one you're on depends on the date of the admission. For a status change happening now, or an admission on or after February 14, 2025, the fast appeal is open, and the January 2026 cutoff below does not apply to it; filing while you're still in the hospital is the quickest route. For an admission between January 1, 2009 and February 13, 2025, the retrospective track applies, and its filing window closed on January 2, 2026: a request after that date is denied unless you establish good cause for filing late, which Medicare illustrates with serious illness or incapacity, a death or serious illness in the immediate family, records lost to fire or disaster, or having been given the wrong information on how to appeal. If you have good cause, file immediately, with the explanation attached.
  • Another payer or setting. Without a qualifying stay, ask whether the care can be delivered somewhere else, such as home health, or covered by another program, such as Medicaid or Veterans' benefits.,

Once you qualify, Part A covers up to 100 days per benefit period, and the cost-sharing changes partway through:

  • Days 1 through 20: $0 each day, after you pay the $1,736 Part A deductible. It is not free outright, but you don't pay that deductible twice: if you already paid it for the hospital stay that got you here, in the same benefit period, you owe nothing further for these 20 days.
  • Days 21 through 100: you pay a daily coinsurance of $217 in 2026, confirmed in the CMS 2026 cost figures.
  • After day 100: Medicare coverage ends, and you're responsible for the full cost.

A benefit period is the unit Part A counts in. It starts the day you're admitted as an inpatient and ends once you have not received inpatient hospital care or skilled care in a SNF for 60 days in a row. That clock can run while you are still in the facility, so a resident who drops from skilled to custodial care can begin a new benefit period without leaving. Because a new benefit period can begin later, the 100-day clock can reset, but only after that 60-day break.

The thing to watch for is the day-100 cliff. SNF coverage is designed for rehabilitation and recovery, not for a permanent stay. The moment a person no longer needs daily skilled care and needs only custodial help, Medicare's payments stop, often well before day 100. Many families discover this when the facility notifies them that skilled coverage is ending and the bill is about to become theirs. If long-term placement is likely, that's the moment to look into Medicaid, which does cover long-term nursing-home care for people who meet its income and asset rules.

Home health care

Home health brings skilled care to you instead of moving you to a facility, and for the right person it's one of Medicare's most useful benefits, partly because it usually costs nothing. Both Part A and Part B can cover it. The catch is that the eligibility rules are specific, and all of them have to be true at once.

You qualify when:

  • A doctor or allowed provider has seen you and set up a care plan they review regularly.
  • You're certified as homebound, meaning leaving home takes a considerable and taxing effort, or your doctor advises against it. You can still leave for medical care or short, infrequent outings and remain homebound.
  • You need intermittent skilled care, specifically intermittent skilled nursing (more than just drawing blood), physical therapy, speech-language pathology, or continued occupational therapy.
  • The care comes from a Medicare-certified home health agency.

When those conditions are met, Medicare covers skilled nursing, physical and occupational therapy, speech-language pathology, medical social services, certain medical supplies, and a home health aide, though aide services are covered only while you're also receiving skilled care, and they end when the skilled service does. "Part-time or intermittent" has a working definition: skilled nursing and aide services combined, generally fewer than 8 hours a day and 28 or fewer hours a week, with up to 35 hours a week allowed on case-by-case review.

Don't skim past that aide, because it's the line families most often leave on the table. Medicare's own examples of covered home health aide care are help with walking, bathing or grooming, changing bed linens, and feeding, which is the same hands-on help the custodial exclusion below names. The two aren't in conflict, because that exclusion applies only when such help is the only care you need. So if a nurse or therapist is already visiting and a daughter is doing the bathing herself, the thing to do is ask the agency for aide hours, not conclude Medicare pays nothing toward them.

What you pay is the part people find surprising. For the covered home health services themselves, you generally owe $0. The one cost is durable medical equipment, things like a wheelchair or walker: Medicare pays 80% of the approved amount and you pay the other 20%, once you've met the Part B deductible.

The exclusions matter as much as the coverage, because this is where the custodial line shows up again. Medicare home health does not cover:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services like shopping and cleaning that aren't related to your care plan
  • Custodial personal care when it's the only care you need

So a person who's stable and needs only all-day help with daily activities won't qualify for home health on that basis, no matter how real the need. The benefit follows the skilled requirement. But note the word only: where a skilled need is in place, the aide hours above are part of the benefit.

Hospice care

Hospice is the benefit Medicare covers most generously, and the one families understand least well until they need it. It's comfort-focused care for someone who is terminally ill, and it shifts the goal from curing the illness to managing pain and symptoms and supporting both the patient and the family.

To elect hospice, all of the following have to be true. You must be entitled to Part A. A hospice doctor and your regular doctor, if you have one, must certify that you're terminally ill with a life expectancy of 6 months or less if the illness runs its normal course. You must accept comfort care instead of care meant to cure the terminal illness and its related conditions, and sign a statement choosing hospice over other Medicare-covered treatments for that illness.

Two things about that choice are worth saying plainly, because misreading either is the commonest reason a family refuses hospice. First, accepting comfort care does not mean stopping all treatment: other medical care can continue as long as it's helpful, so electing hospice doesn't cost a person the ordinary care that manages their other conditions. Second, the decision isn't permanent. A person can leave hospice for a while and enroll again later, as long as a provider still believes they have six months or less to live.

Coverage is organized into benefit periods: two 90-day periods first, then an unlimited number of 60-day periods after that. Each period requires a doctor to recertify that the prognosis still holds, with a face-to-face encounter before the third period and each one after. The six-month figure is a prognosis, not a deadline, and plenty of people live in hospice longer than expected without losing coverage.

Medicare pays for hospice at one of four levels of care, depending on what the situation calls for:

  1. Routine home care, the most common level, day-to-day comfort care wherever the person lives.
  2. Continuous home care, more intensive nursing at home during a short crisis.
  3. Inpatient respite care, a short stay in a facility so a family caregiver can rest.
  4. General inpatient care, for pain or symptoms that can't be managed at home.

Cost sharing on the hospice services themselves is small. You'll pay no more than a $5 copay for each outpatient prescription drug for pain and symptom management, and 5% of the Medicare-approved amount for inpatient respite care, which can't come to more than the inpatient hospital deductible.

Two costs sit outside that, though, and they're the ones that catch families:

  • Room and board. Medicare does not pay room and board when hospice care is given at home, or when you live in a nursing home or a hospice inpatient facility. If your mother is in a nursing home, electing hospice does not hand her monthly bill to Medicare; that facility keeps furnishing, and charging for, the 24-hour room and board. But the same rule carries the exception families need: if the hospice team determines you need short-term inpatient or respite care and arranges it, Medicare covers that stay. Respite is temporary care in a Medicare-approved nursing home, hospice inpatient facility, or hospital so a family caregiver can rest, for up to 5 days at a time, and it costs you the 5% above rather than a room rate.
  • Care the hospice team didn't arrange. Hospital outpatient care such as an emergency room visit, hospital inpatient care, and ambulance transportation can leave you owing the entire cost, unless the care is unrelated to the terminal illness and its related conditions. If the team decides you need inpatient care, they have to make the arrangements, and if they don't, you might pay the whole bill. So the habit worth building is simple: call the hospice team first, before the ambulance.

One point catches Medicare Advantage members off guard: even if you're enrolled in a Medicare Advantage plan, it's Original Medicare, not your MA plan, that covers the hospice benefit. You don't have to switch plans or leave Medicare Advantage to use hospice. What actually happens is broader than the hospice care alone: once you elect hospice, all of your Medicare benefits revert to fee-for-service, which covers the hospice care, your attending physician's services, and any care unrelated to the terminal illness, while you stay on the plan for whatever extra benefits it provides, such as dental or vision.

Does Medicare pay for long-term care? Where these benefits leave off

Run back through the three and the same boundary shows up each time. SNF care stops when daily skilled care is no longer needed. Home health excludes round-the-clock and custodial-only help. Hospice is comfort care, not long-term residence. The skilled requirement is the wall, and on the other side of it sits long-term custodial care, the help with daily living that someone may need for months or years.

Medicare was never built to pay for that. For long-term custodial care, families rely on personal savings, long-term care insurance bought ahead of time, or Medicaid, the program that does cover long-term care for people who meet its financial limits. Knowing this in advance is what keeps a family from being blindsided by a bill the day skilled coverage ends.

Frequently Asked Questions

Does Medicare pay for a nursing home?

It depends on the kind of care. Medicare pays for short-term skilled nursing in a facility, up to 100 days per benefit period, for recovery and rehabilitation. That generally takes a qualifying 3-day inpatient hospital stay, but not always: an ACO or Medicare Advantage waiver, a re-entry within 30 days, an appeal of a switch to observation status, or another payer can each open the door without one. What Medicare does not pay for is long-term custodial care, the ongoing daily-living help most people mean by "nursing home." For that, families turn to private pay, long-term care insurance, or Medicaid.

Why did my SNF coverage end before day 100?

The 100 days is a maximum, not a guarantee. Medicare covers SNF care only while you still need daily skilled care from a nurse or therapist. Once your condition stabilizes and you need only custodial help, coverage ends, sometimes well before day 100. The facility is required to notify you before skilled coverage stops.

How much does home health cost under Medicare?

For covered home health services, you generally pay nothing. The exception is durable medical equipment such as a wheelchair or walker: Medicare pays 80 percent of the approved amount and you pay the other 20%, after you've met the Part B deductible. That 20% is tied to the equipment, not to the home health services themselves.

Can I keep my Medicare Advantage plan and still use hospice?

Yes. Even if you're enrolled in a Medicare Advantage plan, Original Medicare covers your hospice care, not the MA plan, and you don't have to disenroll to elect hospice. Once you do elect it, all of your Medicare benefits revert to fee-for-service, including your attending physician's services and any care unrelated to the terminal illness, while you keep the plan for extras such as dental or vision.

What happens if someone lives longer than six months in hospice?

Coverage continues as long as the prognosis still holds. The six-month figure is a life-expectancy estimate at the point of entry, not a cutoff. Hospice coverage runs through two 90-day periods and then unlimited 60-day periods, each one requiring a doctor to recertify that the person is still terminally ill, with a face-to-face encounter before the third period and each one after.

Does my parent's nursing home bill go away if they elect hospice?

No, and this is the costliest hospice misunderstanding. Medicare does not pay room and board when hospice care is given at home, or when the person lives in a nursing home or a hospice inpatient facility, so that monthly bill stays where it was, and the facility keeps meeting the same round-the-clock personal care and nursing needs it did before. What hospice adds is the comfort care itself, at up to a $5 drug copay and 5% for inpatient respite. The one exception: if the hospice team determines short-term inpatient or respite care is needed and arranges it, Medicare covers that stay.

Is hospice the same as palliative care?

Not quite: hospice is one type of palliative care, but the two aren't interchangeable. Palliative care is comfort and symptom care for anyone living with a serious illness, and it can begin at any stage, even at diagnosis, right alongside treatment meant to cure or control the illness. Hospice is the end-of-life form of palliative care: it's for someone a doctor certifies has about six months or less to live, and electing it means choosing comfort care instead of curative treatment for the terminal illness. So you don't need a six-month prognosis, and you don't have to give up curative treatment, to get palliative care; those conditions are unique to the hospice benefit.

Learn More

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Find personalized help planning a hospital discharge, home care, or hospice with Medicare at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.