Medicare covers up to 100 days in a skilled nursing facility or inpatient rehabilitation hospital per benefit period, but the amount you pay changes after day 20

Medicare Part A pays for rehabilitation care after a hospital stay, but only if you meet specific conditions. You must have been admitted to a hospital for at least three consecutive days, then move directly to a skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) within 30 days. The facility must be Medicare-certified. If these conditions are met, Medicare covers the full cost of days 1 through 20. Starting on day 21, you pay a daily coinsurance amount — currently $194.50 per day in 2024, though this changes each year.

After day 100 in the same benefit period, Medicare stops paying. A benefit period begins the day you enter the hospital and ends 60 days after you leave the facility without being readmitted. If you are readmitted after that 60-day gap, a new benefit period starts and you get another 100 days of coverage.

The length of your actual stay depends on your medical condition and progress in therapy, not on Medicare's 100-day limit. Your doctor and the facility's care team decide when you are ready to go home or move to another level of care. Many people leave before day 100; others may not need the full benefit.

Key Takeaways

  • Medicare Part A covers up to 100 days per benefit period in a skilled nursing facility or inpatient rehabilitation hospital, but only after a may have access to hospital stay of at least three consecutive days.
  • You pay nothing for days 1 through 20; starting on day 21, you pay a daily coinsurance amount that Medicare sets each year.
  • A new benefit period begins 60 days after you leave the facility, which resets your 100-day count and your cost-sharing.
  • Your actual length of stay is determined by your medical progress and your doctor's discharge plan, not by Medicare's coverage limits.
  • If you need care beyond 100 days in one benefit period, you or your family will need to pay out of pocket or explore other payment sources.

What counts as a may have access to hospital stay

The three-day hospital requirement is strict: you must be admitted as an inpatient, not treated in the emergency department or observation status. Observation status looks like a hospital stay but counts differently for Medicare purposes. Ask the hospital directly whether you are admitted as an inpatient or placed in observation — this distinction determines whether your rehabilitation stay will be covered.

The three days do not have to be full 24-hour periods. If you are admitted on a Monday afternoon and discharged Wednesday morning, that counts as three days. You must then move to the rehabilitation facility within 30 days of hospital discharge. If you go home first or to another facility, the clock resets and you lose the connection to that hospital stay.

The difference between skilled nursing facilities and inpatient rehabilitation hospitals

Both types of facilities can provide the 100 days of Medicare coverage, but they serve different needs. A skilled nursing facility (SNF) is usually attached to or part of a nursing home. It provides nursing care, physical therapy, occupational therapy, and speech therapy for people recovering from surgery, stroke, or other acute conditions. SNFs accept patients with varying levels of medical complexity.

An inpatient rehabilitation facility (IRF) is a separate hospital dedicated to intensive rehabilitation. It typically serves patients who can tolerate three hours or more of therapy per day and have conditions like stroke, spinal cord injury, amputation, or severe trauma. IRFs are more specialized and intensive than SNFs. Your doctor will recommend one or the other based on your medical needs and therapy requirements.

Both count toward the same 100-day limit. If you spend 30 days in an SNF and then move to an IRF, you have 70 days of coverage remaining in that benefit period.

What happens when you reach day 100

Once you have used 100 days of coverage in a benefit period, Medicare Part A stops paying for skilled nursing or rehabilitation care. If you still need care at that point, you have three main options: pay out of pocket, use a Medigap or Medicare Advantage plan if you have one, or explore Medicaid coverage if you meet income and asset limits.

Some people transition to custodial care, which is help with daily activities like bathing and dressing but not skilled nursing or therapy. Medicare does not cover custodial care, but Medicaid may, depending on your state and financial situation. Your social worker or discharge planner at the facility can discuss these options with you before day 100 approaches.

If you are discharged before day 100 and later readmitted to a hospital, a new benefit period begins 60 days after your discharge from the facility. This resets your 100-day count. However, if you are readmitted to the hospital within 60 days, you remain in the same benefit period and your 100-day count does not reset.

Your costs during the covered stay

Days 1 through 20 are fully covered by Medicare Part A — you pay nothing if the facility is Medicare-certified and you meet the admission requirements. Your supplemental insurance (Medigap) or Medicare Advantage plan may cover additional costs like copayments for services, but the basic facility charges are covered.

Starting on day 21, you pay a coinsurance amount for each day. In 2024, this is $194.50 per day, but the amount changes annually. This coinsurance is your responsibility; Medicare does not pay it. A Medigap plan (specifically plans C, D, G, or M) will cover this coinsurance if you have one. If you have a Medicare Advantage plan, check your plan documents to see what you owe.

You are also responsible for any charges the facility bills that Medicare does not cover — for example, phone service, television, or private room upgrades. Ask the facility for a written estimate of what you will owe before you are admitted.

How to track your days and understand your notices

The facility must give you a document called the Notice of Medicare Non-Coverage if Medicare determines you no longer need skilled care or if you are approaching the end of coverage. This notice explains why Medicare is ending coverage and tells you how many days you have left. Read it carefully and ask the facility social worker or your doctor if you do not understand it.

You can also request an itemized statement from the facility showing how many days you have used. Keep track yourself by marking a calendar — day 1 is your first full day in the facility, not the day you are admitted. If you believe the facility or Medicare has miscounted your days, you have the right to appeal.

Your hospital discharge paperwork should state the reason for your transfer to rehabilitation and confirm that you meet the three-day inpatient requirement. Keep this paperwork; you may need it if questions arise about coverage.

What to ask your doctor and the facility before admission

Before you enter a rehabilitation facility, ask your doctor: "How many days of therapy do you expect I will need?" and "Do you think I will need more than 100 days of care?" These questions help you understand whether you might run out of Medicare coverage.

Ask the facility: "Is this facility Medicare-certified?" "What will I owe after day 20?" and "What happens if I need care beyond 100 days?" Also ask whether the facility accepts your insurance plan and whether they can estimate your out-of-pocket costs.

If you have a Medigap or Medicare Advantage plan, call your insurance company before admission and ask what they cover during a rehabilitation stay. This prevents surprises when you receive bills.

Frequently Asked Questions

Does Medicare cover rehabilitation at home instead of a facility?

Medicare Part A does not cover facility-based rehabilitation at home. However, Medicare Part B covers skilled nursing care and therapy services delivered in your home if a doctor orders them and you are homebound. Home health services have different rules and limits than facility care. Ask your doctor whether home health is an option for your situation.

What if I need rehabilitation but did not have a three-day hospital stay?

If you did not meet the three-day inpatient hospital requirement, Medicare Part A will not cover a skilled nursing or rehabilitation facility stay. You would need to pay out of pocket or use Medicaid if you meet your state's income and asset limits. Some people in this situation use Medicare Part B to cover home health services instead.

Can I use my remaining days in a new benefit period if I am readmitted?

No. Each benefit period gives you a fresh 100 days. If you use 60 days in one benefit period and then are readmitted to the hospital more than 60 days later, a new benefit period starts and you get another 100 days. However, if you are readmitted within 60 days, you stay in the same benefit period and your 100-day count does not reset.

Will my Medigap plan cover the coinsurance after day 20?

Some Medigap plans cover the daily coinsurance after day 20. Plans C, D, G, and M include this coverage. If you have a different Medigap plan or a Medicare Advantage plan, check your plan documents or call your insurance company to confirm what you owe during days 21 through 100.

What if the facility says I can leave but I do not feel ready?

You have the right to stay longer if your doctor agrees you still need skilled care. However, Medicare will only pay if your doctor documents that skilled nursing or therapy is medically necessary. If Medicare or the facility disagrees, you can appeal the discharge decision. Ask to speak with the facility's patient advocate or social worker about your concerns.