Medicare does not pay for long-term nursing home care in Florida. It pays for short-term skilled nursing care, up to 100 days per benefit period, after a qualifying hospital stay. Once that window closes, or if the care you need is help with daily living rather than daily medical treatment, Medicare stops paying and the bill shifts to you, Medicaid, long-term care insurance, or another source. In Florida, that bill runs roughly $10,300 a month for a semi-private room.
The 100-Day Skilled Nursing Benefit
Medicare Part A covers care in a skilled nursing facility when you need hands-on medical treatment or rehabilitation, not simply a place to live. Think physical therapy after a hip replacement, IV medications, or wound care performed by licensed professionals.1Medicare.gov. Skilled Nursing Facility Care
Three conditions have to be met. First, you need a qualifying inpatient hospital stay of at least three consecutive days, counted from formal admission as an inpatient through the day before discharge. Time spent under observation status or in the emergency room does not count, even if you were there overnight. Second, you must enter a Medicare-certified skilled nursing facility within 30 days of leaving the hospital. Third, a physician must confirm you need daily skilled nursing or therapy for a condition related to that hospital stay.1Medicare.gov. Skilled Nursing Facility Care
If those boxes are checked, here is what you pay in 2026:
- Days 1 through 20: $0 in daily coinsurance.
- Days 21 through 100: $217 per day.2CMS. Medicare Deductible, Coinsurance and Premium Rates: CY 2026 Update
- After day 100: Medicare pays nothing. You owe the full cost.
A benefit period starts the day you are admitted as an inpatient and ends after you go 60 consecutive days without inpatient hospital or skilled nursing care. You can have more than one benefit period, but each one requires meeting the qualifying conditions again, including a fresh three-day hospital stay.1Medicare.gov. Skilled Nursing Facility Care
Why Medicare Stops: The Custodial Care Gap
The coverage gap that catches most Florida families off guard is custodial care. This is the non-medical, day-to-day help that makes up the bulk of what nursing homes actually provide: bathing, dressing, eating, getting in and out of bed, using the bathroom, and moving around. When someone needs this kind of personal care but does not require daily skilled nursing or therapy, Medicare will not cover the stay, no matter how many years they paid into the system.3Medicare.gov. Nursing Home Coverage
The transition from covered to uncovered often happens quietly. Medicare may pay for the first few weeks while you recover from surgery or a stroke and receive daily physical therapy. The moment your condition stabilizes and skilled care is no longer required, coverage ends. You may still need around-the-clock help, but if that help is custodial, you need a different payment source.
Medicare Advantage and Medigap
If you are on a Medicare Advantage plan rather than Original Medicare, your skilled nursing benefits work differently. Some Advantage plans waive the three-day hospital stay requirement, so you could go directly to a skilled nursing facility. Many plans require prior authorization before admission, and most limit you to in-network facilities. Call your plan before any skilled nursing admission to confirm coverage, network status, and authorization. Skipping that step can leave you paying significantly more or the entire stay out of pocket.4Medicare.gov. Medicare Coverage of Skilled Nursing Facility Care
If you have Original Medicare plus a Medigap policy, you can erase most of the out-of-pocket cost. Several standardized Medigap plans, including the popular Plan G, cover 100% of the Part A coinsurance for days 21 through 100, so the $217 daily charge disappears.5Medicare. Compare Medigap Plan Benefits Medigap only works with Original Medicare; it will not help if you are enrolled in a Medicare Advantage plan.
If the Facility Says Medicare Coverage Is Ending
You can push back. The skilled nursing facility must give you a written Notice of Medicare Non-Coverage at least two days before your covered services are scheduled to end. That notice lists an independent reviewer, called a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO), and tells you how to request a fast appeal.6Medicare.gov. Fast Appeals
Call the BFCC-QIO no later than noon the day before the listed termination date. If you file by that deadline, you can stay in the facility while your case is reviewed. The reviewer issues a decision by the close of business the day after it receives the information it needs. This is worth doing when you believe your condition still requires skilled care.6Medicare.gov. Fast Appeals
What Florida Nursing Homes Actually Cost
A semi-private nursing home room in Florida runs roughly $10,300 per month, and a private room averages about $11,500. That is $124,000 to $138,000 a year. South Florida and urban areas tend to run higher; rural parts of the state tend to run lower.
Even at the lower end, those costs will burn through most people’s savings quickly. Medicare’s 100-day benefit, used in full, covers only a small slice of what a multi-year stay costs. That is why most Floridians who need ongoing nursing home care end up on Medicaid or combining several funding sources.
How Floridians Pay for Long-Term Nursing Home Care
Florida Medicaid
Medicaid is the primary government program that pays for long-term nursing home stays in Florida. Unlike Medicare, it covers indefinite custodial care for people who meet income, asset, and medical eligibility rules.
Florida sets the nursing home Medicaid income limit at 300% of the federal SSI benefit. For 2026, the SSI rate is $994 per month, putting the cap at $2,982 per month.7Social Security Administration. SSI Federal Payment Amounts for 2026 Countable assets for a single applicant must generally be $2,000 or less. When only one spouse needs care, the spouse remaining at home may keep up to $162,660 in countable assets in 2026 under the community spouse resource allowance. The home (up to a certain equity value), one vehicle, personal belongings, and prepaid burial arrangements are generally exempt. You must also be assessed as needing a nursing home level of care through Florida’s CARES program.8Florida Department of Children and Families. Guide to the Institutional Care Program (ICP)
Florida is an income-cap state, so if your monthly income exceeds $2,982, you are technically disqualified even when your income is nowhere near enough to pay the nursing home. The workaround is a Qualified Income Trust, often called a Miller Trust. Income above the cap is deposited into the trust each month and paid toward your nursing home costs. As long as the trust is maintained properly, Medicaid treats your income as if it falls below the cap.
Once on Medicaid, nearly all of your income goes toward the cost of care. Florida leaves you a personal needs allowance of $160 per month. If your spouse lives at home, some of your income may be diverted to them as a maintenance allowance depending on their own income.
Watch the Five-Year Look-Back
Federal law establishes a 60-month look-back period for asset transfers. When you apply for nursing home Medicaid in Florida, the state reviews every transfer you made during the five years before your application. Gifts to family, property sold below fair market value, or similar transfers trigger a penalty period of Medicaid ineligibility.9Office of the Law Revision Counsel. 42 U.S. Code 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
The penalty is calculated by dividing the value of what you transferred by Florida’s penalty divisor, which is based on the state’s average monthly nursing home cost. As of 2025, Florida uses a divisor of roughly $10,645. A $106,450 gift to your daughter two years before applying would produce about 10 months of ineligibility, and the clock does not start on the date of the gift. It starts when you would otherwise be eligible for Medicaid, which is usually when you actually need care. That timing is what makes well-intentioned gifts financially devastating.10Florida Department of Children and Families. Appendix A-8 – Transfer Penalty Determination Process
Medicaid Estate Recovery
Florida is required to seek repayment from the probate estates of Medicaid recipients who received benefits after age 55. After the recipient dies, the state files a claim for what it paid on their behalf.11The Florida Legislature. Florida Statutes 409.9101 Recovery is blocked if the recipient leaves behind a surviving spouse, a child under 21, or a child who is blind or permanently disabled, and heirs can request a hardship waiver. Outside those protections, families should know that the house or other probate assets they expected to inherit may be used to repay Medicaid.
Long-Term Care Insurance
Long-term care insurance is designed to cover exactly what Medicare does not: custodial care, room and board, and personal assistance. Most policies impose an elimination period of 30, 60, or 90 days before benefits start, during which you pay out of pocket.12Administration for Community Living. Receiving Long-Term Care Insurance Benefits Policies have to be bought well in advance; premiums rise sharply with age, and insurers can deny coverage based on pre-existing conditions.
VA Aid and Attendance
Veterans who served during wartime and their surviving spouses may qualify for the Aid and Attendance benefit, a monthly pension supplement that helps with long-term care costs. For 2026, the maximum annual benefit is $29,093 for a single veteran with no dependents and $34,488 for a veteran with a spouse or dependent child.13U.S. Department of Veterans Affairs. Current Pension Rates for Veterans The veteran must need help with daily activities, be bedridden, be in a nursing home due to disability, or have severely limited eyesight, and must meet financial eligibility rules.14Veterans Affairs. VA Aid and Attendance Benefits and Housebound Allowance It will not cover the full price of a Florida nursing home, but combined with other sources it meaningfully reduces the burden.
Private Pay
Paying out of pocket with savings, retirement accounts, or income preserves the most flexibility in choosing a facility, and many families use it to bridge the gap between Medicare’s short-term coverage ending and Medicaid eligibility beginning. At $10,000 or more per month, even substantial savings disappear within a few years, which is why private pay is usually a stage rather than a plan.