Medicare covers rehabilitation for a limited time after hospital discharge or skilled nursing care

Medicare Part A pays for inpatient rehabilitation in a skilled nursing facility (SNF) for up to 100 days per benefit period, but only if you meet strict conditions: you must have been admitted to a hospital for at least three consecutive days, and you must need daily skilled nursing or therapy that cannot be done at home. Once you reach day 100, or once Medicare decides you no longer need daily skilled care, the coverage stops. At that point, you have several options depending on your condition, your finances, and what your doctor recommends.

The key is understanding that "running out" of Medicare rehab coverage does not mean you stop getting care — it means you shift from Medicare-covered inpatient care to a different setting or payment method. Some people move to outpatient therapy, some continue at the facility but pay out of pocket, and some transition to home care or community programs. The timing and your next step depend on what your care team and your insurance situation allow.

Key Takeaways

  • Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period, but only after a may have access to hospital stay of at least three days.
  • When Medicare coverage ends, you can continue therapy as an outpatient, stay at the facility and pay privately, or move to home-based care depending on your medical needs and finances.
  • Your facility's discharge planner should tell you in writing when your Medicare coverage will end and what your options are at least two days before that date.
  • If you believe Medicare ended your coverage too early, you have the right to request a review, and your facility must continue care during the appeal period.
  • Supplemental insurance (Medigap) or Medicare Advantage plans may cover some costs after Part A ends, but coverage varies by plan.

Understanding your Medicare rehab benefit before it ends

Your Medicare Part A rehab benefit is tied to a hospital stay. When you are admitted to a hospital, a new benefit period begins. If you are discharged to a skilled nursing facility within one day of leaving the hospital, Medicare will pay for up to 100 days of care there — but only if you continue to need daily skilled nursing or therapy services.

The clock starts on day one of your SNF stay, not day one of your hospital stay. Days 1 through 20 are fully covered by Medicare (you pay nothing). Days 21 through 100 require a daily copay from you (the amount changes yearly; in 2024 it is $200 per day). After day 100 in that benefit period, Medicare stops paying, even if you are still receiving therapy.

Medicare also stops paying before day 100 if your care team determines you no longer need daily skilled care. This is not a penalty — it is how the program is designed. If you are improving and can manage with outpatient therapy or home care instead of a facility, Medicare considers the skilled nursing benefit to have served its purpose.

What your facility must tell you before coverage ends

Federal law requires your SNF to give you written notice at least two days before your Medicare coverage is expected to end. This notice must explain why coverage is ending, what your options are, and what you will owe if you stay. The notice is called a Notice of Medicare Non-Coverage (also called an NMNC). You should receive this even if you are being discharged to go home.

Read this notice carefully. It will tell you the specific date Medicare coverage ends and whether the reason is that you have used 100 days or that your care team believes you no longer need daily skilled services. If you disagree with the reason, you can request a review — and this is important: your facility must continue to provide care and bill Medicare while your appeal is being decided.

If you do not receive a written notice, ask your case manager or discharge planner for one when ready. Do not wait until the day coverage ends to find out what happens next.

Continuing therapy after Medicare coverage ends

The most common path after Medicare Part A ends is outpatient rehabilitation. If your doctor believes you still benefit from physical therapy, occupational therapy, or speech therapy, you can receive these services in an outpatient clinic, your home, or a community center. Medicare Part B covers outpatient therapy, though it has its own limits and copays.

Outpatient therapy through Medicare Part B is subject to a combined annual limit. In 2024, Medicare covers up to $2,430 per year for physical therapy and speech-language pathology combined, and up to $2,430 per year for occupational therapy (these amounts change yearly). You pay 20 percent of the cost after you meet your Part B deductible. Many people find that outpatient therapy is less intensive than facility-based care but allows them to continue improving at home.

Your discharge planner should help arrange outpatient therapy before you leave the facility. Ask them to set up your first appointment and to send your medical records to the outpatient provider. If you are going home, ask whether your insurance covers home health visits, which can include therapy delivered by a nurse or therapist in your own home.

Staying at the facility and paying out of pocket

Some people choose to remain at the SNF after Medicare coverage ends and pay for care privately. This is your right, but it is expensive. The cost of a skilled nursing facility typically ranges from $200 to $400 per day or more, depending on location and the level of care you need. Before you commit to this option, understand the full cost and how long you can afford it.

If you have a Medigap policy (supplemental insurance), check your plan documents to see whether it covers SNF costs after Medicare Part A ends. Some Medigap plans cover the daily copay for days 21 through 100, but few cover costs after day 100. If you have a Medicare Advantage plan, call the plan to ask what it covers after Part A ends — coverage varies widely.

Before paying out of pocket, ask the facility's business office whether they offer a payment plan, whether they accept Medicaid (which might cover costs if you meet income limits), or whether they have financial information programs. Some facilities will work with you on cost if you ask directly.

Appealing if you believe coverage ended too early

If you think Medicare ended your coverage before you were ready to leave the facility, you have the right to request a review. This is called a Quality Improvement Organization (QIO) review. You must request it within 120 days of receiving your Notice of Medicare Non-Coverage.

To request a review, contact your state's QIO. Your facility should provide the QIO phone number in your non-coverage notice. You can also call Medicare at 1-800-MEDICARE and ask for your state QIO's contact information. Tell the QIO that you disagree with the decision to end coverage and explain why you believe you still need daily skilled care.

While your appeal is pending, the facility must continue to provide care and bill Medicare. You are not responsible for the bill during the appeal period, even if Medicare ultimately agrees with the original decision to end coverage. This protection is important: it means you can challenge the decision without fear of a sudden bill.

Planning ahead to avoid gaps in coverage

The best time to plan for the end of Medicare rehab coverage is before it happens. Ask your care team and discharge planner these questions at least one week before your expected discharge or coverage end date:

  • What is my expected discharge date or the date Medicare coverage will end?
  • Will I be discharged to home, or will I stay at the facility and pay privately?
  • What outpatient therapy or home care services does my doctor recommend?
  • Does my insurance cover outpatient therapy, and are there any limits?
  • What is the cost to me if I stay at the facility after Medicare coverage ends?
  • Are there community programs, senior centers, or low-cost therapy options in my area?

Having these answers in writing before coverage ends means you will not face a sudden gap in care or a surprise bill. If your facility does not provide clear answers, ask to speak with the social worker or case manager, whose job is to help you plan the transition.

Frequently Asked Questions

Can I stay at the facility after day 100 if I pay myself?

Yes. Once Medicare coverage ends, you can stay and pay privately if you choose and if the facility agrees. However, you will pay the full daily rate out of pocket — typically $200 to $400 per day or more. Check your Medigap or Medicare Advantage plan first to see whether any costs are covered. Some facilities offer payment plans or financial information if you ask.

What if I run out of money while I am still at the facility?

Contact the facility's social worker or business office when ready. You may be able to transition to Medicaid if you meet income and asset limits, or the facility may have a charity care program. Some facilities will work out a payment plan. Do not ignore bills or assume you must leave — there are options, but you need to ask for help.

Does my Medicare Advantage plan cover rehab differently than Original Medicare?

Medicare Advantage plans must cover at least what Original Medicare covers, but many offer additional benefits. Some cover more days of SNF care or lower copays. Call your plan to ask what it covers after Part A ends. Your plan documents should also spell this out, though calling is faster than reading the fine print.

If I appeal and lose, do I have to pay the bill for the days I stayed while appealing?

No. While your appeal is pending, the facility must continue care and bill Medicare. If Medicare upholds its decision to end coverage, you are not responsible for those bills. The facility absorbs the cost. This is why appealing is worth doing if you genuinely believe you still need skilled care.

What is the difference between outpatient therapy and home health therapy?

Outpatient therapy means you travel to a clinic or facility for appointments. Home health therapy means a therapist or nurse comes to your home. Both are covered by Medicare Part B, but home health is usually recommended if you have mobility problems or live far from a clinic. Ask your doctor which makes sense for your situation.