What Medicare Covers in a Skilled Nursing Facility

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

Medicare Part A will pay for a skilled nursing facility (SNF) — a place where you receive medical care and rehabilitation after leaving the hospital — but the coverage has strict rules. You must have spent at least three consecutive days in a hospital first, you must be admitted to the SNF within 30 days of leaving the hospital, and a doctor must order the care for a condition related to your hospital stay. Medicare does not cover long-term custodial care or help with daily living if skilled medical care is not the main reason you are there.

The facility itself must be Medicare-certified, which most nursing homes are. Your doctor does not choose the facility for you — you do, as long as it accepts Medicare and participates in the program. If you go to a facility that is not Medicare-certified, Medicare will not pay.

Key Takeaways

Medicare Part A covers the first 20 days of SNF care at no cost to you after a may have access to hospital stay of at least three days.
Days 21 through 100 require a daily copay (the amount changes yearly) and you pay the full cost after day 100 in the same benefit period.
The SNF must be Medicare-certified and the admission must happen within 30 days of your hospital discharge for the same condition.
Medicare covers skilled nursing care and rehabilitation therapy, but not custodial care, personal care, or help with activities of daily living alone.
Your hospital stay must be three consecutive calendar days (not counting the discharge day) to may have access to for SNF coverage.

What counts as a may have access to hospital stay

You need at least three consecutive calendar days in the hospital before Medicare will cover a SNF stay. The day you are discharged does not count toward those three days. If you are in the hospital on Monday, Tuesday, and Wednesday and discharged on Thursday, that counts. If you are admitted on Monday evening and discharged on Tuesday morning, that does not count as three days.

The hospital stay must be for the same condition (or a related one) that requires the SNF care. If you are hospitalized for pneumonia and then admitted to a SNF for pneumonia recovery and physical therapy, that qualifies. If you are hospitalized for pneumonia but then admitted to a SNF for knee replacement recovery, that does not may have access to — the SNF stay must relate to why you were in the hospital.

How much Medicare pays and what you pay

Medicare Part A covers the full cost of the first 20 days of SNF care with no out-of-pocket cost to you. Starting on day 21, you pay a daily copay amount that Medicare sets each year. This copay is typically one-quarter of the hospital deductible, though the exact amount changes annually. You are responsible for the full cost of any stay that goes beyond 100 days in a single benefit period.

A benefit period runs from the day you enter the hospital until you have been out of any hospital or SNF for 60 consecutive days. If you are discharged and then readmitted after those 60 days, a new benefit period begins and your day count resets to 1.

These costs cover room, board, nursing care, therapy, and medical equipment used in the facility. They do not cover items you bring from home, phone calls, television, or personal care items.

What types of care Medicare covers in a SNF

Medicare covers skilled nursing care — wound care, injections, catheter management, and monitoring of complex medical conditions — and rehabilitation therapy including physical therapy, occupational therapy, and speech therapy. A registered nurse or licensed therapist must provide or supervise the care for it to count as skilled care.

Medicare does not cover custodial care, which is help with bathing, dressing, eating, toileting, and moving around when skilled medical care is not involved. If you need a SNF only because you cannot bathe or dress yourself, Medicare will not pay. If you need a SNF because you need wound care after surgery and also happen to need help bathing, Medicare covers the wound care and the facility stay, but the facility bills you separately for the custodial help.

Therapy must be medically necessary and aimed at improving your condition or restoring function. If therapy is ordered but you are not making progress, Medicare may stop paying even if you are still in the facility.

The 30-day window and choosing a facility

You must be admitted to the SNF within 30 days of your hospital discharge. If you are discharged on a Monday and admitted to a SNF on the following Tuesday, that is within the window. If you go home for 35 days and then enter a SNF, Medicare will not cover it — you would need another may have access to hospital stay.

You choose which Medicare-certified SNF to use. Your hospital discharge planner can give you a list of facilities in your area, but the choice is yours. Before you are discharged, ask the hospital which facilities are Medicare-certified and whether they have bed availability. Some facilities fill up quickly, so it helps to know your options before you leave the hospital.

If you are admitted to a SNF that is not Medicare-certified, you will receive a notice explaining this, and Medicare will not pay. You are responsible for the full bill. Always confirm the facility is Medicare-certified before admission.

What happens after 100 days or when you are discharged

After 100 days in a SNF during a single benefit period, Medicare stops paying and you are responsible for all costs. Some SNFs accept Medicaid at this point if you meet Medicaid income and asset limits, but Medicaid rules vary by state. Others may offer a private rate or work out a payment plan. Discuss this with the facility's billing department before you reach day 100.

When your doctor determines you no longer need skilled care, you will be discharged. This may happen before day 20, between days 21 and 100, or after day 100. The facility must give you written notice before discharge and explain your rights. If you disagree with the discharge decision, you can request a review.

After discharge, Medicare does not cover ongoing help at home unless it is skilled care ordered by your doctor — such as physical therapy or wound care. Help with daily activities at home is not covered by Medicare Part A.

Medicare Advantage and SNF coverage

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your SNF coverage may be different. Some Advantage plans cover SNF stays the same way Part A does; others have different rules, limits, or copays. You must use a facility in your plan's network, and you may need prior approval from your plan before admission.

Check your plan documents or call your plan's customer service before you are discharged from the hospital to understand what your plan covers. If you are unsure, ask the hospital discharge planner to contact your plan on your behalf.

Frequently Asked Questions

What if I go to a SNF without a hospital stay first?

Medicare will not pay. You must have a may have access to hospital stay of at least three consecutive days, and the SNF admission must happen within 30 days of discharge. If you need SNF care without a hospital stay, you would need to pay out of pocket or use Medicaid if you meet the requirements.

Can I choose any nursing home, or does it have to be a specific one?

You can choose any Medicare-certified SNF, but it must accept Medicare and be in your area. Ask your hospital discharge planner for a list of certified facilities. If you have a Medicare Advantage plan, the facility must be in your plan's network.

What if my doctor says I need more than 100 days of SNF care?

Medicare stops paying after 100 days in a benefit period, regardless of medical need. After day 100, you pay the full cost unless you may have access to for Medicaid or another program. Talk to the facility's social worker about payment options and whether you may be may be able to access for Medicaid in your state.

Do I need to pay anything during the first 20 days?

No. Medicare Part A covers the full cost of days 1 through 20 at no cost to you. You may have other costs, such as for items the facility does not provide or services not covered by Medicare, but the SNF care itself is fully covered.

What if I am discharged and then need to go back to the hospital?

If you are readmitted to the hospital within 60 days of your SNF discharge, you are still in the same benefit period. Your day count in the SNF does not reset. If you are readmitted after 60 days, a new benefit period begins and you start over at day 1 for SNF coverage.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.