Medicare covers rehabilitation for up to 100 days in a skilled nursing facility (SNF) per benefit period, but the amount you pay changes after day 20, and coverage can end sooner if you no longer need daily skilled care.

The length of your coverage depends on what type of rehab you need and where you receive it. If you're in a hospital and then move to a skilled nursing facility for physical therapy, occupational therapy, or speech therapy, Medicare Part A pays the full cost for the first 20 days. From day 21 through day 100, you pay a daily coinsurance amount (in 2024, this is $194.50 per day, though this amount changes yearly). After day 100 in the same benefit period, Medicare stops paying.

The catch is that Medicare can stop paying before day 100 if a doctor determines you no longer need daily skilled nursing care. This happens more often than people expect. If your progress plateaus or your condition stabilizes, the facility or Medicare may decide you're ready for outpatient therapy or home care instead, and your coverage ends.

Key Takeaways

  • Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period, with full coverage for days 1–20 and coinsurance required for days 21–100.
  • Coverage ends when ready if a doctor determines you no longer need daily skilled care, even if you haven't used all 100 days.
  • A new benefit period begins 60 days after you leave the hospital or skilled nursing facility, which resets your 100-day count.
  • Outpatient rehabilitation, home health therapy, and therapy in other settings have different coverage rules and may not count against your 100-day limit.

When Your 100-Day Clock Starts and Stops

Your 100-day benefit period begins the day you are admitted to a skilled nursing facility, not the day you leave the hospital. You must have been an inpatient in a hospital for at least three consecutive days (not counting the day you leave) to may have access to for skilled nursing facility coverage under Medicare Part A. If you go directly from home to a skilled nursing facility without a hospital stay, Medicare does not cover it.

The 100 days reset when you have been out of a hospital or skilled nursing facility for 60 consecutive days. If you leave a facility on day 50 and return on day 110, you start a new benefit period with a fresh 100 days. If you return on day 59, you continue using days from your original benefit period.

What Happens on Day 21 and Beyond

Days 1 through 20 are fully covered by Medicare Part A with no out-of-pocket cost to you (assuming you've met your Part A deductible for the year). Starting on day 21, you enter a coinsurance period where you pay a daily amount while Medicare covers the rest. In 2024, this daily coinsurance is $194.50, but it increases each year with inflation.

Many people assume they can stay the full 100 days if they keep paying coinsurance. That is not how it works. A doctor or the facility's care team can discharge you from skilled nursing care at any point if they determine you no longer require daily skilled nursing services. This decision is based on your medical condition and progress, not on how many days you have left.

Why Coverage Ends Before Day 100

The most common reason coverage stops early is that your condition has improved enough that you no longer need 24-hour nursing supervision or daily skilled therapy. Medicare defines "skilled care" narrowly: it means care that requires a nurse or therapist to deliver it safely and effectively. Once your therapy becomes routine or your medical condition stabilizes, you may be discharged to outpatient care or home health instead.

If you disagree with a discharge decision, you have the right to appeal. The facility must give you written notice at least two days before discharge, and you can request a Quality Improvement Organization (QIO) review within one day of receiving the notice. The QIO is an independent organization that reviews whether the discharge is medically appropriate. During the appeal, Medicare continues to pay while the review is pending.

Coverage in Different Settings

Skilled nursing facility care is not the only type of rehabilitation Medicare covers. The rules differ depending on where you receive therapy:

  • Inpatient rehabilitation facility (IRF): These are hospitals specializing in intensive rehabilitation. Medicare covers the full cost after you meet your Part A deductible, with no daily limit, but only if you need the intensity of an inpatient setting. Length of stay varies by medical need.
  • Home health therapy: If you are homebound and need skilled care, Medicare Part A or Part B can cover physical therapy, occupational therapy, and speech therapy at home. There is no day limit, but coverage depends on medical necessity and your homebound status.
  • Outpatient rehabilitation: Therapy at a hospital outpatient department or independent therapy clinic is covered under Medicare Part B. You pay 20% coinsurance after meeting your annual deductible. There is no day limit, but your doctor must order it and it must be medically necessary.

Understanding Your Benefit Period

A Medicare benefit period is not the same as a calendar year. It begins the day you are admitted to a hospital and ends 60 days after you leave a hospital or skilled nursing facility without being readmitted. If you are readmitted within those 60 days, you are still in the same benefit period and your 100-day skilled nursing count continues from where it left off.

This matters because if you use 60 days of skilled nursing care, leave for 61 days, and return, you start fresh with 100 new days. But if you return on day 59, you only have 40 days left from your original 100. Many people do not realize this and are surprised when their coverage runs out sooner than expected on a second stay.

What You Should Do Before Discharge

Before you leave a skilled nursing facility, ask the care team what happens next. Will you continue therapy at home, at an outpatient clinic, or will therapy end? If therapy continues, ask whether it will be covered and under what part of Medicare. Request a written discharge plan that lists your medications, any equipment you need at home, and the names and phone numbers of any therapists or doctors you should see.

If you are being discharged and you believe you still need skilled care, you can request an appeal before you leave. Do not wait until after discharge—your right to appeal is strongest while you are still in the facility. Ask to speak with the facility's patient advocate or social worker if you have questions about your discharge.

Frequently Asked Questions

Can I stay in a skilled nursing facility longer if I pay out of pocket?

Yes. Once Medicare stops paying, you can remain in the facility and pay privately if you wish and the facility agrees. However, you should understand the cost: private pay rates at skilled nursing facilities typically range from $200 to $400 per day or more, depending on location and level of care. Ask the facility for a written estimate before committing.

What if I need more therapy after my 100 days are up?

You may be able to continue therapy through home health, outpatient rehabilitation, or an outpatient hospital program. These have different coverage rules and do not count against your 100-day limit. Your doctor must order the therapy and it must be medically necessary. Talk to your discharge planner about which option fits your needs.

Does my Part B deductible explore to skilled nursing facility care?

No. Skilled nursing facility care is covered under Medicare Part A, which has its own deductible. In 2024, the Part A deductible is $1,632 per benefit period. Part B deductibles explore only to outpatient services like doctor visits and outpatient therapy.

If I leave a facility and come back within 60 days, do I start over with my 100 days?

No. If you return within 60 days, you are still in the same benefit period and continue counting from where you left off. For example, if you used 45 days, left, and returned within 60 days, you have 55 days remaining. You only get a fresh 100 days if you stay out for 60 consecutive days.

Who decides when I am no longer may be able to access for skilled nursing care?

A doctor and the facility's care team make this decision based on your medical condition and whether you still need daily skilled nursing services. If you disagree, you can request a QIO review within one day of receiving your discharge notice. The QIO will determine whether the discharge is medically appropriate.