Skilled Nursing vs. Custodial Care, the 3-Day Rule & How to Cover What Medicare Doesn't

MEDICARE MONDAY Episode 10 | July 13th, 2026

Presenter:

Bradley Birdsell | Trusted Insurance Advisor at American Republic Insurance Services

In this episode of Medicare Monday, Bradley Birdsell from American Republic Insurance Services sits down to explain a topic many Central Illinois families mix up:

Skilled Nursing Care Versus Long-Term Custodial Care.

Bradley clarifies that Medicare typically helps with skilled care — services from licensed professionals such as a registered nurse or physical therapist in a skilled nursing facility, rehab center, or similar setting. Custodial or long-term personal care is generally not covered by Medicare.

He also walks through the Medicare 3-day (72-hour) inpatient rule. To qualify for skilled nursing benefits, you usually need a qualifying inpatient hospital stay of at least 72 hours. Meet that rule and you may be eligible for up to 100 days of skilled nursing coverage. The challenge today: many hospital stays are classified as outpatient/observation, which can make it harder to meet that 72-hour requirement.

Original Medicare: Days 1–20 typically at no cost; days 21–100 can carry a daily coinsurance (cited in the episode at $217/day); after day 100, costs are generally 100% out of pocket.

Medicare Advantage: Copays or coinsurance usually apply during the first 100 days and then vary by plan.

Medicare Supplement (Medigap): Can cover the skilled nursing coinsurance for approved stays during those 100 days.

Because Medicare covers only a small share of longer nursing-home type costs, he outlines two common ways to fill the gap: a long-term care policy (watch the typical 90-day elimination period) and a short-term care / recovery care policy that can pay from day one — if you can still qualify medically.

Watch now for a clear breakdown of skilled vs. custodial care, the 3-day rule, and how Original Medicare, Advantage, and Medigap treat skilled nursing stays.

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