What Medicare covers: skilled care after a hospital stay
Medicare Part A covers care in a Medicare-certified skilled nursing facility (SNF) for a limited time when all of these are true:
- You had a qualifying inpatient hospital stay of at least three days in a row, counting the day you were admitted but not the day you left.
- You enter the SNF within a short time, generally 30 days, of leaving the hospital.
- Your doctor says you need daily skilled care, such as nursing or therapy, from or supervised by skilled staff.
| Days in a benefit period | You pay in 2026 (Original Medicare) |
|---|---|
| Days 1–20 | $0 |
| Days 21–100 | $217 per day |
| Days 101 and after | All costs |
Medicare Advantage plans cover SNF care too, and some waive the three-day stay, but costs and rules such as prior authorization differ.
What Medicare doesn't cover: long-term custodial care
Medicare.gov says Medicare and Medigap don't pay for long-term custodial care, the help with bathing, dressing and using the bathroom that most nursing home residents need. Medicare still covers doctor visits, hospital care and Part D drugs while you live there.
How NC Medicaid pays for nursing homes
- Apply for NC Medicaid. Your county Department of Social Services (DSS) decides whether you meet the financial rules; apply through ePASS or the DSS office.
- Meet the medical rules. A special NC Medicaid review team decides whether you need nursing facility care.
- Know how income counts. North Carolina doesn't use an income cap for nursing home Medicaid, so no special income trust is needed. Your income goes toward your care, and NC Medicaid can pay the rest if your income is less than the home's private rate plus medical bills (manual MA-2270).
- Pay your monthly share. You pay a patient monthly liability after a personal needs allowance and other deductions. Medicare is billed first.
- Know about estate recovery. Under G.S. 108A-70.5, North Carolina can recover some Medicaid costs from the estates of people 55 and older. See does NC Medicaid take your house.
Would rather stay home? The CAP/DA waiver pays for care at home for adults who need a nursing-home level of care, though it has had a statewide waitlist since February 2024. More in does NC Medicaid pay for nursing home care.
Choosing a nursing home in North Carolina
Compare inspection results and staffing on Medicare's Care Compare. The regional long-term care ombudsman at your area agency on aging can explain options and residents' rights. A licensed insurance agent who works with Benefits Life can explain how Medicare, Medigap and Medicare Advantage handle SNF stays, at no cost to you: you can request a call from a licensed insurance agent.
Related questions
Does Medicare cover assisted living in North Carolina?
Adult care homes and Special Assistance.
Does Medicare cover home health care?
Skilled care at home.
How do I get rides to the doctor?
County DSS rides and more.
Sources
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Long-term care
- NC Medicaid — Nursing Facilities
- NCDHHS — Adult Medicaid Manual MA-2270, Long Term Care Need and Budgeting (revised June 16, 2026)
- North Carolina General Statutes — G.S. 108A-70.5, Medicaid Estate Recovery Plan
- NCDHHS Division of Aging — Long-Term Care Ombudsman
- NCDHHS — Hotlines
More questions in this guide
- Can I keep my doctor when I go on Medicare in North Carolina?
- Does Medicare cover assisted living in North Carolina?
- Does Medicare cover dental in North Carolina?
- Does Medicare cover eye exams and glasses in North Carolina?
- Does Medicare cover hearing aids in North Carolina?
- Does Medicare cover home health care in North Carolina?
- Does Medicare cover mental health care in North Carolina?
- How do I get rides to the doctor with Medicare in North Carolina?
Part of the guide: Medicare basics for North Carolinians · All questions
Frequently asked questions
What do I pay for a skilled nursing facility stay in 2026?
Under Original Medicare you pay nothing for days 1 to 20, $217 a day for days 21 to 100, and all costs after day 100 in a benefit period. Many Medigap plans pay the daily coinsurance for days 21 to 100.
Does time in the hospital under observation count toward the three days?
No. Medicare counts only the days you were formally admitted as an inpatient, not time under observation or in the emergency room, and not the day you leave. Ask the hospital whether you are an inpatient or an outpatient under observation.
Who can help with a problem at a North Carolina nursing home?
North Carolina's Long-Term Care Ombudsman Program has 16 regional ombudsman offices in the area agencies on aging that help residents with complaints and rights. To report a care problem to the state licensing agency, call the NCDHHS Division of Health Service Regulation complaint intake line at 1-800-624-3004.
Medicare in your North Carolina county
Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →
