03/19/2026
⏳ This is an updated version of a post I ran about a month ago on Medicare and nursing home coverage. The comments were full of questions, so here are the 2026 rules.
Medicare covers up to 100 days of skilled nursing facility care per benefit period. It does not cover long-term custodial care. Days 21 through 100 cost $217 per day in coinsurance for 2026.
A new benefit period starts only after 60 consecutive days outside the hospital or SNF. Leaving for 3 days does not restart the clock.
Under Original Medicare, a hospital stay classified as "observation" does not satisfy the required 3-day inpatient stay. Some Medicare Advantage plans and certain ACO initiatives can waive that rule.
Medicaid eligibility for nursing home coverage is state-specific. In many states, the 2026 income cap is $2,982 per month and countable assets must be reduced to roughly $2,000 for a single applicant.
A community spouse can keep up to $162,660 under the 2026 Community Spouse Resource Allowance, and the home is generally exempt while that spouse lives there.
After death, most states pursue estate recovery. The home is usually the largest asset involved. A Medicaid Asset Protection Trust can shield it, but only if it has been in place for at least 5 years before the application.
The national median for a semi-private nursing home room is about $115,000 per year. Long-term care insurance can offset that cost, but premiums rise sharply if you wait past 60 to buy a policy.