Medicare vs Medicaid for Nursing Home Care: What Each Actually Pays
Medicare covers short rehabilitation stays; Medicaid covers long-term care once assets are spent down. Most families are surprised by which one they will rely on.
Free-to-use photo via Pexels (Photo by a Pexels contributor); no attribution required by license, credited here as courtesy.
Medicare pays for skilled nursing facility care only after a qualifying inpatient hospital stay of at least three days, and only while the resident needs daily skilled care. It covers days 1–20 in full, days 21–100 with a daily co-insurance ($209.50 per day in 2025), and nothing after day 100 in a benefit period. Medicare never pays for custodial long-term care — help with bathing, dressing and eating without a skilled need.
Medicaid is the main payer for long-term nursing home care in the USA. Eligibility is income- and asset-based and set by each state; a single applicant can typically keep only about $2,000 in countable assets, with a five-year look-back on transfers. Nearly all of the resident's monthly income then goes to the facility as a "patient liability", with a small personal-needs allowance kept.
Why "accepts Medicaid" matters on our pages
A facility that is Medicare-only will require a resident to leave when Medicare or private funds run out. Every facility we grade shows whether it participates in Medicare, Medicaid or both — the CMS "provider type" field — and you can filter state lists by it.
Other payers
- Long-term care insurance: pays a daily benefit after an elimination period; policies bought before 2010 often have the most generous terms.
- VA Aid and Attendance: a pension supplement for wartime veterans and surviving spouses who need daily help.
- Private pay: the national median for a semi-private room was about $9,300 a month in 2024 (Genworth Cost of Care survey).