Medicare covers inpatient rehabilitation in a skilled nursing facility after a hospital stay, but only if you meet specific conditions and your doctor orders it as medically necessary.

Medicare Part A (hospital insurance) will pay for up to 100 days of care in a skilled nursing facility (SNF) following a hospital stay of at least three consecutive days. The facility must be Medicare-certified, and a doctor must document that you need daily skilled nursing or rehabilitation services that cannot be provided at home.

The catch: Medicare does not cover custodial care — help with daily living tasks like bathing or dressing — unless it is bundled with skilled care you genuinely need. If you are recovering from a hip fracture and need physical therapy plus wound care, you may have access to. If you mainly need help getting dressed and taking medication, you do not.

Key Takeaways

  • Medicare Part A covers up to 100 days in a skilled nursing facility after a may have access to hospital stay, but you must have been admitted as an inpatient for at least three consecutive days.
  • You pay nothing for days 1 through 20, a daily copay (currently $200 per day) for days 21 through 100, and all costs after day 100.
  • The facility and your doctor must agree the care is skilled — physical therapy, occupational therapy, speech therapy, or skilled nursing — not just help with daily tasks.
  • If you go home instead of to a facility, Medicare Part B covers outpatient therapy at a clinic or your home through a home health agency, with different cost rules.
  • You have the right to appeal if Medicare or the facility says you no longer need skilled care and tries to discharge you early.

What "Skilled Nursing Facility" Means and Why It Matters

A skilled nursing facility is not the same as an assisted living facility or a nursing home that provides only custodial care. A Medicare-certified SNF has registered nurses and therapists on staff and provides medical oversight. The facility must be able to deliver the specific therapy or nursing service your doctor ordered — usually physical therapy, occupational therapy, speech-language pathology, or wound care.

When you are discharged from the hospital, the hospital discharge planner will tell you whether your doctor has ordered SNF care and will help you find a facility that has an available bed. Not all nursing homes are certified as SNFs, so the planner cannot send you to just any facility. You can request a specific facility if it is Medicare-certified and has a bed, but the hospital cannot force you to go to one you choose if it is full.

If you and your doctor decide you do not need inpatient rehab and you go home instead, Medicare Part B will cover outpatient physical therapy, occupational therapy, or speech therapy through a clinic or home health agency — but the rules and costs are different.

How Much Medicare Pays and What You Pay

For days 1 through 20 in a skilled nursing facility, Medicare Part A covers all approved costs. You pay nothing during this period.

For days 21 through 100, you pay a daily copay. The copay amount changes each year; in 2024 it is $200 per day. Medicare pays the rest of the approved charges. After day 100, Medicare pays nothing and you are responsible for all costs, unless you have supplemental insurance (Medigap) or Medicaid that covers the gap.

These costs explore only to the facility itself — room, board, nursing care, and therapy. If you need hospital outpatient services, imaging, or lab work while you are in the SNF, those may be billed separately under Part B rules, and you may owe a copay or coinsurance for those services.

The Three-Day Hospital Stay Rule

To may have access to for SNF coverage, you must have been admitted to the hospital as an inpatient for at least three consecutive calendar days before transfer. Observation status does not count — only inpatient admission. This distinction matters because some people spend two or three days in the hospital on observation status (meaning the doctor has not yet decided whether to admit you) and then are told they do not may have access to for SNF coverage.

If you are unsure whether you were admitted as an inpatient or placed on observation status, ask the hospital billing department or your discharge planner. You can also request an itemized bill, which will show your status. If you believe you should have been admitted as an inpatient and were not, you have the right to appeal the hospital's decision through the Quality Improvement Organization in your state.

When Medicare Stops Paying and You Can Appeal

Medicare and the SNF must document that you are making progress toward your rehabilitation goals and that you still need daily skilled care. If either party decides you no longer need skilled services, they can discharge you. This can happen even if you have not used all 100 days.

You have the right to appeal if you disagree with a discharge decision. When the facility or Medicare notifies you that your coverage is ending, you will receive a notice called a Notice of Medicare Non-Coverage. This notice tells you the reason and gives you the right to request a Quality Improvement Organization (QIO) review — an independent review by a state contractor that decides whether the discharge is appropriate.

You must request the QIO review within 120 days of the notice. If you request it before your discharge date, Medicare will continue to pay while the review is pending. If you wait until after discharge, you may owe the facility for those days. Contact your state's QIO directly — your facility or the notice will provide the phone number — or call Medicare at 1-800-MEDICARE.

Outpatient Rehab at Home or a Clinic Instead of a Facility

Not everyone needs inpatient rehab in a facility. If you can safely recover at home with outpatient therapy, Medicare Part B covers physical therapy, occupational therapy, and speech-language pathology through a clinic or a home health agency. The rules are different: there is no three-day hospital stay requirement, no 100-day limit, and no daily copay structure.

For outpatient therapy at a clinic, you typically pay a copay per visit (usually $20 to $50, depending on your plan). For home health services, Medicare covers the full cost of skilled nursing and therapy visits if a doctor orders them and you are homebound or have difficulty leaving home. You pay nothing for home health services covered by Part A, though some supplies may have a copay.

Your hospital discharge planner can discuss whether outpatient therapy is appropriate for your situation. If you choose to go home, make sure your doctor writes an order for the specific therapy you need and the frequency — for example, "physical therapy three times per week for six weeks." Without a doctor's order, the therapy will not be covered.

What to Ask Before You Leave the Hospital

Before discharge, ask your hospital discharge planner these questions: Am I being admitted as an inpatient or on observation status? Has my doctor ordered skilled nursing facility care, or will I do outpatient therapy at home? If SNF care is ordered, which facilities have beds available and accept Medicare? If I am going home, what therapy has my doctor ordered and where will I receive it?

Request a written copy of your discharge plan and your doctor's orders. This document will help you and the SNF or therapy provider understand what services are covered and what you are expected to do at home. If you do not understand the plan or have questions about costs, ask before you leave the hospital — it is much harder to sort out later.

Frequently Asked Questions

Can I choose which skilled nursing facility I go to?

Yes, you can request a specific Medicare-certified facility, but the hospital cannot may provide a bed there. The discharge planner will tell you which facilities have available beds and will help you contact them. If your preferred facility is full, you can ask to be placed on a waiting list or choose another facility.

What happens if I run out of Medicare coverage before I am ready to go home?

After day 100, Medicare pays nothing. If you have Medigap supplemental insurance or Medicaid, those programs may cover some or all costs. If not, you and your family are responsible for the facility's charges. Talk to the facility's billing department about payment plans or financial hardship options before your coverage ends.

Does Medicare cover therapy at home after I leave the facility?

Yes, if your doctor orders it. Medicare Part B covers outpatient therapy at a clinic or through a home health agency. Home health services are covered under Part A if you are homebound and a doctor orders skilled nursing or therapy. You pay nothing for home health services covered under Part A.

What if my doctor says I do not need a facility but I am worried about going home alone?

Discuss your concerns with your doctor and discharge planner. If you need help with daily tasks but not skilled care, Medicare will not cover facility care, but you may be able to hire a home aide privately or explore community resources like meal delivery or transportation services. Some areas have programs that help older adults with non-medical support.

Can I appeal if the facility says I have to leave before I am ready?

Yes. If you receive a Notice of Medicare Non-Coverage, you can request a Quality Improvement Organization review within 120 days. If you request it before your discharge date, Medicare will keep paying while the review happens. Call your state's QIO or Medicare at 1-800-MEDICARE to start the appeal.