Someone breaks a hip. After surgery, the hospital says they need rehab in a skilled nursing facility. The family relaxes because "Medicare covers 100 days," right? Sometimes. The rules are strict, and one common mistake ends the coverage before it starts. Here is how Medicare actually pays for skilled nursing facility care.
The short answer
Medicare Part A covers up to 100 days per benefit period in a skilled nursing facility (SNF). Days 1 to 20 are 100% covered. Days 21 to 100 have a daily copay (about $209.50 per day in 2025; check current CMS rates for 2026). After day 100, you pay everything.
To get coverage, you need a qualifying 3-day inpatient hospital stay first. Observation status does not count. Coverage ends when you stop needing daily skilled care.
What is a skilled nursing facility?
A skilled nursing facility, or SNF, is a place that provides short-term medical care from licensed professionals. Not the same as a nursing home for long-term custodial care, even though the buildings sometimes look alike.
SNF care includes:
- Physical therapy after surgery or a stroke
- Occupational therapy to relearn daily tasks
- Speech therapy
- Wound care and IV medications
- Skilled nursing observation
- Tube feeding, catheter care, injection management
The key word is "skilled." The care must require a licensed nurse or therapist, not just an aide.
What Medicare pays and what you pay
| Day of stay | Medicare pays | You pay |
|---|---|---|
| Days 1 to 20 | 100% of Medicare-approved cost | $0 |
| Days 21 to 100 | Everything above the daily copay | Approx $209.50/day (2025; check 2026 rates) |
| Day 101 and beyond | $0 | Everything |
The copay for days 21 to 100 adds up quickly. At $209.50 per day, 80 days is about $16,760 out of pocket without other coverage.
This is where Medigap earns its keep. Plan G and Plan F cover that entire daily copay. Even Plan N covers it. You pay $0 for the full 100 days if you have most Medigap letters.
The 5 rules Medicare uses to approve SNF care
Medicare will not pay unless all five of these are true:
1. You had a qualifying inpatient hospital stay
You must have been formally admitted as an inpatient for at least 3 consecutive nights. Not observation status. Not the ER. Actually admitted.
The 3 days do NOT include the day of discharge. So a "3-day stay" is really 3 midnights in an inpatient bed.
2. You moved into the SNF within 30 days of leaving the hospital
You have 30 days after hospital discharge to enter the SNF. Miss that window and coverage does not apply.
3. Your doctor certifies you need daily skilled care
A doctor must order daily skilled nursing or therapy. Not just help with dressing or eating.
4. The care is for the condition you were hospitalized for (or something that developed during the SNF stay)
The reason for SNF is related to the hospital admission. Cannot be unrelated.
5. The facility is Medicare-certified
Not every SNF accepts Medicare. Verify before admission using Medicare.gov Care Compare.
What Medicare covers inside the SNF
When Medicare approves the stay, it covers:
- Semi-private room
- Meals
- Skilled nursing care
- Physical, occupational, and speech therapy
- Medications you get in the facility
- Medical supplies and equipment used in the facility
- Ambulance transportation to needed medical services outside the SNF
- Dietary counseling
What Medicare does NOT cover in a SNF:
- Private room (unless medically needed)
- Private duty nursing
- TV, phone, personal items
- Custodial care alone (help bathing, dressing, eating without skilled care)
The benefit period explained
Medicare counts SNF days in "benefit periods," not calendar years. A benefit period:
- Starts the day you enter the hospital or SNF
- Ends when you have been out of the hospital and SNF for 60 consecutive days
Once a benefit period ends, a new one can start with a new hospital stay. Each new benefit period gets a fresh 100 SNF days. But you also owe a new Part A deductible for the hospital.
So it is possible to use up 100 days, go home for 60 days, come back, and get 100 more days if you qualify again.
The therapy improvement myth
A common story: Medicare cuts off SNF care because the patient is "not improving." Not true.
Medicare requires "maintenance therapy" too. If skilled care is needed to prevent decline, that counts. This was clarified by the Jimmo v. Sebelius settlement in 2013.
If a SNF says Medicare is stopping your coverage because you have "plateaued":
- Ask for the reason in writing
- File an expedited appeal (you have 24 to 48 hours)
- Contact your State Health Insurance Assistance Program (SHIP) for free help
Appeals are often successful. Do not just accept the discharge notice.
Skilled care vs custodial care
This is the line Medicare draws.
| Skilled care (Medicare covers) | Custodial care (Medicare does NOT cover) |
|---|---|
| Wound care from a nurse | Help with a shower |
| IV antibiotics | Help getting dressed |
| Physical therapy after hip surgery | Reminding to take pills |
| Tube feeding management | Cooking meals |
| Diabetes management with skilled monitoring | Simple hygiene help |
Once your care needs shift entirely to custodial, Medicare stops paying, even if you still have days left. Long-term custodial care in a nursing home is not a Medicare benefit. See the top 10 things Medicare does not cover.
Medicare Advantage and SNF care
Medicare Advantage plans must cover skilled nursing care, but they can use different rules:
- Some plans waive the 3-day hospital rule (a plus)
- Many require prior authorization for SNF admission (a hassle in a crisis)
- Copays vary by plan, sometimes higher than Original Medicare
- You must use in-network SNFs (limits your choice)
Advantage plans have been criticized for denying or ending SNF stays faster than Original Medicare. Federal rules from 2024 tightened this up. But if SNF risk is a real concern for you, Original Medicare with Medigap gives you the most predictable outcome.
Real example: hip surgery recovery
Judy, 74, has hip replacement surgery. Hospital stay is 4 nights inpatient. She transfers to a SNF for rehab.
With Original Medicare only:
- Days 1-20 at SNF: $0
- Days 21-40 at SNF: 20 days × $209.50 = $4,190
- Total SNF out-of-pocket: $4,190
With Original Medicare + Medigap Plan G:
- Days 1-100: $0
- Total out-of-pocket: $0
The SNF copay is one of the biggest hidden risks in Original Medicare without Medigap. See the top 10 hidden Medicare costs.
Common mistakes
Not confirming inpatient status at the hospital
Ask on day 1 and every day: "Am I inpatient or observation?" Get it in writing if you can.
Waiting too long to move to SNF
The 30-day window from hospital to SNF matters. Do not delay.
Accepting an early discharge notice
If the SNF tries to cut you off, appeal. You have specific appeal rights on Medicare's notice form.
Choosing a non-Medicare-certified facility
Always verify certification with Medicare.gov before admission.
Assuming a nursing home stay is covered
Long-term nursing home care is NOT Medicare. Only short-term skilled care after a hospital stay is covered.
Choosing a good skilled nursing facility
Not all SNFs are equal. The hospital discharge planner may hand you a list. Before you accept the first one, check:
- Star rating on Medicare.gov Care Compare: 4 or 5 stars is preferred. Anything under 3 stars deserves a closer look.
- Staffing levels: How many hours of nursing care per resident per day? Higher is better.
- Recent inspection reports: Care Compare shows citations and complaints from the last three years.
- Distance from family: If your loved ones cannot visit, care quality often suffers.
- Medicare-certified: Confirm the facility accepts Medicare. Not every nursing home does.
Ask if the facility has openings before the hospital discharges. Good SNFs fill up. Sometimes the discharge planner pushes a facility because it has a bed, not because it is the best fit.
What happens after 100 days?
When Medicare's SNF coverage runs out, you have a few paths:
- Go home with home health care: If you no longer need skilled 24/7 care, Medicare can cover home health nursing and therapy. See our home health coverage guide.
- Long-term custodial care in the SNF: Pay out of pocket ($6,000 to $12,000 per month, depending on region).
- Long-term care insurance: If you have a policy, benefits can start here.
- Medicaid: If your assets and income qualify, Medicaid can pay for long-term nursing home care.
Planning ahead matters. Many families do not realize Medicare will not cover long-term nursing home care until they hit day 101.
Where to get help
If you or a family member is heading to a SNF and something feels off:
- Call 1-800-MEDICARE for the official rules
- Contact your State Health Insurance Assistance Program (SHIP) for free counseling
- Ask the SNF's social worker or discharge planner for help with appeals
The bottom line
Medicare covers up to 100 days per benefit period in a skilled nursing facility, but you need a qualifying 3-day inpatient hospital stay first. Days 1-20 are free. Days 21-100 have a big daily copay that Medigap covers. After day 100, Medicare pays nothing.
Long-term nursing home care is a separate problem. Medicare does not cover it. Plan for it with long-term care insurance, savings, or Medicaid planning.
If you want the least financial surprise from a SNF stay, Original Medicare with a strong Medigap plan (G or F) is the setup. Not sure if that fits your budget? Book a free call and we will run the numbers together.
Frequently asked questions
How many days does Medicare cover in a skilled nursing facility?
Up to 100 days per benefit period. Days 1-20 free, days 21-100 have a daily copay, day 101 on you pay everything.
What is the 3-day rule for Medicare skilled nursing care?
You must have a qualifying inpatient hospital stay of at least 3 consecutive nights before Medicare will cover SNF care. Observation status does NOT count.
Does Medicare cover long-term care in a nursing home?
No. Medicare only covers short-term skilled care after a hospital stay. Long-term custodial care needs long-term care insurance, private pay, or Medicaid.
Does Medigap cover skilled nursing facility copays?
Yes. Plan G, Plan F, and most Medigap letters cover the daily coinsurance for days 21-100.
What is the difference between skilled nursing and custodial care?
Skilled means licensed medical care like IV therapy or physical therapy. Custodial means help with daily activities like bathing. Medicare covers skilled care, not custodial.