Medicare covers skilled nursing facility care, but only after a hospital stay and only for specific medical needs

Medicare Part A pays for a portion of your stay in a skilled nursing facility (SNF) — a residential facility where nurses and therapists provide medical care — but the coverage has strict rules. You must have been admitted to a hospital for at least three consecutive days, be admitted to the SNF within 30 days of leaving the hospital, and need daily skilled nursing or rehabilitation services that cannot be provided at home. Medicare does not cover custodial care, which is help with daily activities like bathing or dressing when no medical treatment is involved.

The facility must be Medicare-certified, meaning it has met federal standards for staffing and care. Not all nursing homes are certified for Medicare; some accept only private pay or Medicaid. Before admission, confirm with the facility that it accepts Medicare and that your doctor believes your care meets Medicare's definition of skilled care.

Key Takeaways

  • Medicare Part A covers up to 100 days in a skilled nursing facility per benefit period, but you pay nothing for days 1–20 and a daily copay for days 21–100.
  • You must have a may have access to hospital stay of at least three consecutive days and be admitted to the SNF within 30 days of hospital discharge.
  • Medicare covers the cost of the room, meals, nursing care, therapy, and medical equipment, but does not cover private-duty nurses or amenities like phone or television.
  • If you need care beyond 100 days or do not meet the hospital-stay requirement, you will pay out of pocket or use Medicaid if you meet income and asset limits.
  • The facility must provide written notice of what Medicare will and will not cover before or at admission.

How the 100-day benefit period works

Medicare Part A covers up to 100 days in a skilled nursing facility during each benefit period. A benefit period begins the day you enter a hospital and ends 60 days after you leave the hospital or skilled nursing facility, whichever is later. If you are readmitted to a hospital more than 60 days after your last discharge, a new benefit period starts, and you get another 100 days of SNF coverage.

You pay nothing for the first 20 days. Starting on day 21, you pay a daily copay amount set by Medicare each year — in 2024, this is $194.50 per day, though this amount changes annually. After day 100, Medicare pays nothing, and you are responsible for all costs unless you have a supplemental insurance policy or meet Medicaid income limits.

The 100 days do not have to be consecutive. If you leave the facility and return within the same benefit period, the days you already used count toward your 100-day limit. For example, if you stay 30 days, go home, and return 10 days later, your second stay begins on day 31 of your 100-day allowance.

What Medicare covers in a skilled nursing facility

Medicare Part A covers the semi-private room (two beds), all meals, nursing care provided by registered nurses and licensed practical nurses, physical therapy, occupational therapy, speech-language pathology, and medical social services. It also covers medications administered in the facility, medical equipment such as wheelchairs or walkers, and lab work and X-rays ordered by your doctor.

Medicare does not cover a private room unless it is medically necessary, a private-duty nurse, television or telephone service, personal care items like toiletries, or any care that is purely custodial. Custodial care means information with activities of daily living — bathing, dressing, eating, toileting — when no skilled medical treatment is being provided. If your only need is help with these activities, Medicare will not pay, even if you are in a certified facility.

The facility must provide you with a written notice explaining what Medicare covers and what you will pay before you are admitted or at the time of admission. Keep this notice; it describes your rights and what to expect regarding costs.

The three-day hospital stay requirement

To use your Medicare SNF benefit, you must have been an inpatient in a hospital for at least three consecutive calendar days when ready before admission to the SNF. Observation status does not count — only inpatient status. This distinction matters: some people spend time in a hospital on observation, which means they are not officially admitted as an inpatient, and those days do not satisfy the three-day requirement.

Ask the hospital before discharge whether you were admitted as an inpatient or placed on observation. If you were on observation and your doctor wants to send you to a skilled nursing facility, you will not have Medicare SNF coverage unless you are admitted as an inpatient for at least three days. You can request an inpatient admission if your medical condition warrants it.

The three days must occur when ready before the SNF admission. If you go home for more than 30 days after hospital discharge and then enter a SNF, the hospital stay no longer counts, and you will not have SNF coverage for that admission.

What you pay out of pocket

For days 1 through 20 of your SNF stay, Medicare Part A covers 100 percent of the cost. You are responsible only for any charges the facility makes that Medicare does not cover — such as a private room upgrade, phone service, or personal items — and these are separate from the daily copay.

For days 21 through 100, you pay a daily copay. In 2024, this copay is $194.50 per day. Medicare pays the rest of the facility's charges for covered services. After day 100 in the same benefit period, you pay the full cost of the facility unless you have supplemental insurance, Medicaid coverage, or other resources.

If you have a Medigap (supplemental insurance) policy, it may cover some or all of your daily copay for days 21–100. Check your policy documents or call your insurance company to confirm. If you have limited income and assets, you may be able to use Medicaid to cover costs after Medicare ends, but Medicaid rules vary by state.

When Medicare SNF coverage ends

Medicare stops paying for your SNF care when one of these occurs: you have used all 100 days in your benefit period, your doctor determines you no longer need skilled care, you are discharged from the facility, or you move to a different level of care (such as going home or to a hospital). The facility must notify you in writing if Medicare coverage is ending and explain what you will owe going forward.

If you disagree with the decision to end coverage, you have the right to appeal. The facility must give you written notice at least two days before Medicare coverage ends, and you can request a review by a Quality Improvement Organization (QIO). The QIO will examine whether your care still meets Medicare's definition of skilled care. During the appeal process, you may still owe the daily copay, but if the appeal is successful, Medicare will cover the disputed days retroactively.

If you need care beyond 100 days, explore whether you meet Medicaid income and asset limits in your state, whether you have long-term care insurance, or whether you can pay privately. Some facilities offer payment plans or can connect you with social services to discuss options.

How to find a Medicare-certified skilled nursing facility

Use the Medicare Care Compare tool on Medicare.gov to search for certified SNFs in your area. The tool shows which facilities accept Medicare, their inspection history, staffing levels, and quality ratings. You can also call your hospital's discharge planner — they often have relationships with local facilities and can recommend options based on your medical needs and location preferences.

Before admission, confirm in writing that the facility is Medicare-certified and that your doctor's orders for your care meet Medicare's definition of skilled nursing or rehabilitation. Ask the facility to explain what Medicare will cover and what you will pay. Request a copy of the Skilled Nursing Facility Notice of Medicare Coverage, which the facility is required to provide.

If you are being discharged from the hospital, the discharge planner should help coordinate the transfer. If you are entering a SNF from home (for example, after an injury), you will need a doctor's order for skilled care and a referral to the facility. Your primary care doctor or the urgent care center that treated you can provide this referral.

Frequently Asked Questions

Do I need a doctor's order to go to a skilled nursing facility?

Yes. Your doctor must order skilled nursing or rehabilitation services and document that you need daily medical care or therapy that cannot be provided at home. The facility uses this order to determine whether your care meets Medicare's definition of skilled care and to justify the stay to Medicare if it is audited.

What happens if I run out of my 100 days while still in the facility?

The facility must notify you in writing at least two days before your 100 days end. After day 100, you are responsible for all charges unless you have supplemental insurance, Medicaid coverage, or other payment sources. You can appeal the end of coverage if you believe you still need skilled care, but you may owe the daily rate while the appeal is pending.

Can Medicare cover a skilled nursing facility stay if I was never hospitalized?

No. Medicare SNF coverage requires a may have access to hospital stay of at least three consecutive days as an inpatient. If you need skilled care but have not been hospitalized, Medicare will not cover a SNF stay. You may be able to receive skilled nursing services at home through Medicare home health, or you can pay privately or use Medicaid if you meet income limits.

Does Medicare cover the cost of rehabilitation therapy in a skilled nursing facility?

Yes. Physical therapy, occupational therapy, and speech-language pathology are covered services in a Medicare-certified SNF if they are ordered by your doctor and medically necessary. These services are included in the facility's daily rate; you do not pay extra for them beyond the daily copay for days 21–100.

What is the difference between a skilled nursing facility and a nursing home?

A skilled nursing facility provides 24-hour nursing care and rehabilitation services for people recovering from illness or injury. A nursing home (also called a long-term care facility) may provide custodial care only, with less intensive medical oversight. Not all nursing homes are certified for Medicare, and not all provide skilled care. Medicare covers SNF stays that meet its criteria; it does not cover custodial-only care in any setting.