When Medicare Stops Nursing Home Payments: What to Know

Imagine you’ve just helped a loved one get home from the hospital, and now they’re settling into a skilled nursing facility (SNF) to recover. For a little while, Medicare steps in and covers the cost, giving you a sigh of relief. Then, the clock ticks past a certain point, and suddenly the payments stop. What does that mean for you, and how can you stay ahead of the curve?

In this friendly, down‑to‑earth guide we’ll walk through why Medicare sometimes pays, exactly when it stops, and—most importantly—what you can do when the safety net disappears. Think of it as a conversation over coffee, with lots of useful tips, real‑world stories, and a dash of encouragement.

Why Medicare Pays

What Is Medicare SNF Coverage?

Medicare SNF coverage—often called “skilled nursing facility” coverage—is part of Medicare Part A (Hospital Insurance). It steps in when a doctor determines you need “skilled” care that can only be provided by licensed medical professionals. That includes things like IV medication administration, wound care, or daily physical therapy.

According to Medicare.gov, Part A may cover skilled nursing care in a nursing home if it is medically necessary. This is the foundation of why you might see Medicare paying for a short‑term stay.

Which Medicare Part Covers Nursing‑Home Care?

Part	What It Covers	Coinsurance	Typical Limits
Part A	Skilled nursing, therapy, semi‑private room	Days 1‑20: $0 / day Days 21‑100: $204 / day (2024)	Up to 100 days per benefit period
Part C (Medicare Advantage)	Often adds extra benefits (e.g., private rooms) but follows the 100‑day limit	Varies by plan; may include $0 copay for days 1‑20	Depends on contract with facility

Eligibility Requirements

To unlock Medicare’s SNF benefits you need:

• A minimum three‑day hospital stay (the “qualifying stay”).
• A doctor’s order stating daily skilled care is required.
• Admission to a Medicare‑certified nursing home.
• Enrollment in Medicare Part A (or a Part C plan that includes SNF coverage).

Skilled vs. Custodial Care

Skilled care involves clinical services that a licensed professional must provide—think wound dressing changes or physical therapy. Custodial care, on the other hand, is assistance with everyday activities (ADLs) like bathing, dressing, or eating. Medicare does not cover custodial care on its own.

Healthline notes that Medicare “doesn’t cover care in a nursing home when a person only needs custodial care”【source】. That distinction is why the phrase “Medicare stops nursing home” often pops up when someone transitions from skilled to custodial care.

Coverage Limits

How Many Days Does Medicare Pay?

Here’s the timeline most people encounter:

• Days 1‑20: Medicare covers 100 % of the approved costs.
• Days 21‑100: You pay a daily coinsurance (around $204 in 2024).
• Day 101 onward: Medicare stops paying entirely.

After day 100, the facility can no longer bill Medicare for your stay—this is the moment the headline “Medicare stops nursing home payments” becomes a reality.

Early Termination Triggers

Even before hitting day 100, coverage can end if:

• The doctor determines you no longer need daily skilled services.
• You’re readmitted to the hospital, which can reset the benefit period.

What About Medicare Advantage?

Most Advantage plans follow the same 100‑day rule, but some offer extra perks—like private rooms or reduced coinsurance—if the facility has a contract with the plan. Always check your plan’s summary of benefits; the details can differ a lot.

After Payment Ends

Do You Have to Move Out?

Good news: Medicare can’t simply kick you out of the building because its checks stop. However, if the nursing home can’t accept any other payer (like Medicaid or private pay), they may ask you to find another facility. The rights summary from eHealthInsurance makes it clear that residents can’t be discharged solely because Medicare coverage ends.

New Cost Responsibilities

Once Medicare stops, you’ll be on the hook for:

• Room and board (including meals).
• Any custodial care services.
• Therapies that are no longer deemed “skilled.”

Staying in the Same Facility

If the nursing home accepts Medicaid or your private payment, you can stay right where you are. That’s why many families start the Medicaid application process well before day 101—they want to avoid a disruptive move.

Timing Is Critical

Most facilities give you a 30‑day notice before they must end services for non‑payment reasons. Starting the conversation early gives you breathing room to explore alternatives.

Your Options

Apply for Medicaid

Medicaid is the most common safety net once Medicare stops. Eligibility is based on income and asset limits that vary by state. In many cases, you’ll need to “spend down” assets to meet the threshold. Medicaid eligibility criteria can be found on each state’s health department website.

Long‑Term Care Insurance

If you bought a long‑term care (LTC) policy before needing care, it can pick up where Medicare leaves off—covering room, board, and custodial services. Keep in mind:

• Policies often have a “waiting period” before benefits start.
• Coverage limits vary; read the fine print.

Out‑of‑Pocket Payments

Unfortunately, many families end up paying directly. According to Genworth’s 2023 Cost of Care Survey, a private nursing‑home room averages $9,584 per month. If you’re budgeting for this, consider:

• Setting up a dedicated savings account.
• Exploring financial counseling services that specialize in senior care.

Home‑Based Alternatives

Sometimes the best solution is to move care back home. Home health aides, adult‑day programs, and “aging‑in‑place” modifications can provide the same level of support without the hefty facility fees. A recent article from HumanCareNY explains how families transition to home‑based care after Medicare stops paying【source】.

Veterans’ Benefits & Other Federal Programs

If your loved one served in the military, the VA may cover nursing‑home care or provide a VA‑concessioned facility. Additionally, programs like “Aid & Attendance” add a monthly stipend for eligible veterans.

State‑Specific Assistance

Many states run their own nursing‑home assistance programs. For example, California’s In‑Home Supportive Services (IHSS) can fund a caregiver who provides care in the home, while other states have “community‑based waivers” that subsidize facility costs.

Plan Ahead

Start the Conversation Early

Ideally, begin discussing care goals 6‑12 months before a planned discharge. Ask questions like, “What level of care will I need?” and “What does my doctor think about the timeline?” Early dialogue gives you time to line up finances and paperwork.

Document Medical Necessity

Keep copies of the physician’s order, the discharge summary, and the SNF care plan. These documents become crucial when you apply for Medicaid or appeal a coverage decision.

Create a Financial “Spill‑Over” Plan

Draft a simple spreadsheet that tracks:

• Medicare‑covered days left.
• Projected out‑of‑pocket costs after day 100.
• Potential sources of payment (Medicaid, LTC insurance, savings).

Check Facility Certification

Use the Medicare Care Compare tool to ensure the nursing home is Medicare‑certified and to see quality ratings. A certified facility is more likely to accept Medicaid or private pay later on.

File a “Stay‑On‑If‑Needed” Request

Some states allow residents to request that the facility keep them after Medicare ends, especially if the home is Medicaid‑certified. Your social worker can help file the request and navigate any local paperwork.

Update Advance Directives

Make sure a durable power of attorney, living will, and any DNR orders reflect your current wishes. These documents safeguard your preferences if you become unable to speak for yourself.

Putting It All Together

When Medicare stops nursing home payments, the situation can feel like a sudden roadblock—but it’s also an invitation to explore other pathways. Here’s a quick recap:

1. Know the limits: Medicare covers up to 100 days of skilled care; after that, you’re on your own.
2. Don’t panic about moving: You can often stay if the facility accepts another payer.
3. Explore alternatives early: Medicaid, LTC insurance, out‑of‑pocket funds, and home‑based care are all on the table.
4. Plan ahead: Documentation, financial spreadsheets, and advance directives keep you in control.

Remember, you’re not alone on this journey. Reach out to a certified Medicare counselor, a geriatric social worker, or a trusted attorney to walk through the paperwork together. Their expertise can turn a confusing maze into a clear roadmap.

Take the Next Step

Feeling a little overwhelmed? That’s normal. Grab a cup of tea, open a new document, and start filling in the details outlined above. If you have questions—maybe about how Medicaid works in your state or whether your LTC policy will cover certain services—drop a comment below or reach out to a local senior‑care agency. You deserve peace of mind, and with the right plan, you can keep your loved one safe, comfortable, and well‑cared for, even after Medicare’s checks stop.