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If you’re researching skilled nursing facilities for you or a loved one, or wondering about coverage for post-hospital care, there’s a lot to digest. You’re likely trying to navigate the complex differences between Medicare and Medicaid, and how each program affects your options for quality care.
What does Medicare and Medicaid cover when it comes to skilled nursing care, exactly? Both programs help to cover the costs of a skilled nursing facility (SNF), but they work very differently. Medicare typically covers short-term rehabilitation stays after a hospital visit, while Medicaid focuses on long-term care needs.
Skilled nursing care can be costly, and not all insurance covers it the same way. That’s why many patients and their families turn to Medicare and Medicaid, which cover skilled nursing in different ways. Here’s an overview of the key differences:
| Medicare and Medicaid Coverage for Skilled Nursing | ||
| Feature | Medicare | Medicaid |
| Eligibility requirements | People 65+ or with certain disabilities | People with low income and assets (thresholds vary from state to state) |
| Skilled nursing coverage | Short-term (up to 100 days) | Short-term and long-term coverage |
| Custodial care coverage | Not included | If the patient qualifies financially; patient liability costs apply |
| Cost coverage | 100% for the first 20 days, coinsurance required for the remaining 80 days | 100% cost coverage if the eligibility criteria are met; patient liability costs apply |
| Long-term care coverage | Not included | Included; patient liability costs apply |
| Is a prior hospital stay required? | Yes (3-day minimum) | No |
Medicare can cover skilled nursing care, but only under certain conditions. It’s important to know that Medicare doesn’t cover long-term care in a nursing home. It only pays for short-term stays in a skilled nursing facility. Here’s what Medicare Part A covers for skilled nursing.
| Medicare Part A Coverage in a Skilled Nursing Facility | ||
| Days in Skilled Nursing Facility | What Medicare Covers | What You Pay |
| Days 1-20 | 100% of costs | $0 |
| Days 21-100 | Most of the costs | Coinsurance of $209.50 in 2025 |
| After 100 days | $0 | Full cost |
For eligible patients, Medicare covers these skilled nursing services:
Medicare Part A provides the most comprehensive coverage for SNF stays, but only under these specific conditions:
While Medicare focuses on short-term rehabilitation, Medicaid is the primary payer for long-term skilled nursing care. As long as you meet the strict income and asset requirements, Medicaid covers medical services and personal care assistance.
Medicaid usually covers:
Medicaid eligibility requires meeting both income and asset limits, which vary by state. In most states, individuals can have no more than $2,000 in countable assets, though some assets, like your primary residence, vehicle, and personal belongings, do not count toward this limit.
Like assets, income limits vary depending on your state. If your income is over your state’s Medicaid limit, you may have to “spend down” your excess income on medical expenses to qualify for Medicaid coverage.
In a skilled nursing facility, “patient liability” with Medicaid refers to the portion of the monthly cost of long-term care that the resident is required to pay out of their own income before Medicaid covers the rest.
For example, if a resident’s monthly income is $1,200 and their state’s personal needs allowance is $40, the resident must put the remaining $1,160 towards the cost of long-term care in the nursing facility. Medicaid pays for the remainder of the SNF’s daily or monthly fee.
Medicaid patient liability only applies when the resident is on Medicaid long-term care coverage, meaning their Medicare days are exhausted or the resident was never eligible for Medicare. Then, Medicaid becomes the primary payer for room and board and patient liability starts.
So, what does Medicare and Medicaid cover for skilled nursing? While Medicare provides coverage for short-term rehabilitation needs, Medicaid is the safety net for long-term care.
Whether you’re facing an upcoming surgery, managing a chronic condition, or planning for future care needs, knowing how these programs work together helps ensure you receive quality care without unexpected financial hardship.
Don’t navigate these complex coverage decisions alone. Contact Nightingale to speak with our dedicated Business Office Manager about how Medicare and Medicaid coverage work at our facilities. Let us help you understand your options for skilled nursing care.