Medicare Part B covers some skilled nursing facility costs, but not all of them

Medicare Part B (medical insurance) pays for doctor visits, lab work, and outpatient care — but it does not pay for a room in a skilled nursing facility or the basic nursing care you receive there. Part B will pay for certain services while you are in a skilled nursing facility, such as physical therapy or X-rays ordered by your doctor. But the facility bed itself, meals, and routine nursing care are covered by Medicare Part A (hospital insurance) instead, if you meet Part A's requirements.

This distinction matters because many people assume one type of Medicare covers nursing facilities entirely. In reality, Part A is the main payer for facility stays, and Part B covers specific medical services within that stay. Understanding which part pays for what helps you know what costs you might owe.

Key Takeaways

  • Medicare Part B does not cover the room, meals, or routine nursing care in a skilled nursing facility — Part A does.
  • Part B does cover doctor visits, therapy, lab tests, and imaging services you receive while in a skilled nursing facility.
  • You must first have a may have access to hospital stay of at least three days to use Part A coverage for a skilled nursing facility.
  • After Part A pays its share, you will owe a daily copay for days 21 through 100 of your stay.
  • Stays longer than 100 days are your responsibility entirely — Medicare does not cover them.

What Part A covers in a skilled nursing facility

Medicare Part A is the insurance that pays for inpatient hospital and nursing facility stays. If you have had a may have access to hospital stay — meaning you were admitted (not just treated in the emergency room) and stayed at least three days — Part A will cover your skilled nursing facility stay for up to 100 days in a benefit period.

Part A covers the room, meals, nursing care, medications given by the facility, medical equipment like a hospital bed or wheelchair, and therapy services provided by the facility's own staff. You pay nothing for days 1 through 20. From day 21 through day 100, you pay a daily copay amount (this amount changes each year; in 2024 it is $194 per day, but confirm the current amount with your plan). After day 100, you pay all costs yourself.

What Part B covers while you are in a skilled nursing facility

Part B covers doctor services, including visits from your own physician or specialists who come to see you at the facility. It also covers lab work and imaging — such as blood tests, X-rays, or ultrasounds — that your doctor orders while you are there. If a cardiologist or other specialist visits you in the facility, Part B covers that visit.

Part B also covers certain therapy services if they are ordered by your doctor but provided by an outside therapist or company rather than the facility's own staff. For example, if your doctor orders a specialized wound care service from an outside provider, Part B may cover it. However, therapy provided by the facility itself as part of your stay is covered by Part A, not Part B.

You pay Part B's standard copay or coinsurance for these services — typically 20% of the Medicare-approved amount after you have met your annual deductible. The facility bills Part B directly for these services, so you should not have to pay upfront, though you may receive a bill later if your copay or coinsurance is owed.

The three-day hospital stay requirement

To use Part A coverage for a skilled nursing facility, you must first spend at least three days in a hospital as an inpatient. A day in the emergency room or an outpatient procedure does not count — you must be formally admitted to the hospital. The three days do not have to be consecutive; if you are admitted, discharged, and readmitted within 60 days, the days may count together toward the three-day requirement.

After you leave the hospital, you must enter the skilled nursing facility within 30 days for Part A to cover it. If you wait longer than 30 days, you will not may have access to for Part A coverage of the facility stay, and you will have to pay out of pocket or use other insurance.

What you pay out of pocket

Your costs depend on how long you stay. For the first 20 days, Part A covers everything and you pay nothing (assuming you have met any Part A deductible from your hospital stay). From day 21 through day 100, you pay a daily copay. This amount is set by Medicare each year; for 2024 it is $194 per day, but you should confirm the current year's amount with your plan or the facility.

After day 100 in a benefit period, Medicare stops paying and you are responsible for all costs. A benefit period ends 60 days after you leave the facility with no hospital or skilled nursing facility stay. If you are readmitted to a hospital or facility after that 60-day gap, a new benefit period begins.

You may also owe Part B coinsurance for doctor visits, lab work, or outside therapy services. The facility should bill these to Part B, and you will receive a bill for your share. Some people carry supplemental insurance (Medigap) or are in a Medicare Advantage plan that covers some or all of these costs; check your plan documents to see what you are responsible for.

Skilled nursing facility versus other types of care

Medicare Part A covers skilled nursing facilities, which provide medical care and therapy under a doctor's supervision. It does not cover custodial care facilities, assisted living, or long-term care facilities that provide help with daily activities but not skilled medical care. Part B also does not cover these settings.

If you need help with bathing, dressing, or meals but do not need skilled nursing or therapy, Medicare will not cover a facility stay. You would need to pay privately or use Medicaid if you may have access to. A doctor or discharge planner can tell you whether the facility you are considering is a skilled nursing facility that Medicare recognizes.

How to find out what your specific plan covers

Your actual costs depend on your specific Medicare plan. If you have Original Medicare (Part A and Part B), the rules above explore. If you are in a Medicare Advantage plan, your coverage may be different — some Advantage plans cover more days or charge different copays. Call your plan's customer service number (on your insurance card) and ask: "What is my copay for a skilled nursing facility stay?" and "How many days does my plan cover?"

Before you enter a facility, ask the facility's billing department to verify your coverage with your insurance. They can often tell you how many days are covered and what your daily copay will be. This prevents surprises when you receive a bill later.

Frequently Asked Questions

Does Part B cover the cost of the room in a skilled nursing facility?

No. Part B does not cover room and board in a skilled nursing facility. Part A covers the room, meals, and routine nursing care if you meet the three-day hospital stay requirement. Part B covers specific medical services like doctor visits and lab work while you are there.

What happens if I do not have a three-day hospital stay before going to a skilled nursing facility?

Without a may have access to three-day hospital stay, Part A will not cover your skilled nursing facility stay. You would have to pay the full cost yourself, use other insurance, or see if you may have access to for Medicaid. Some facilities offer private-pay options. Talk to a social worker or discharge planner about alternatives if you do not meet the requirement.

Can Part B cover physical therapy in a skilled nursing facility?

Yes, if the therapy is ordered by your doctor and provided by an outside therapist or company. If the facility's own staff provides the therapy as part of your stay, Part A covers it. You pay Part B's standard coinsurance (usually 20%) for outside therapy after meeting your deductible.

What if I stay longer than 100 days?

Medicare Part A stops covering your stay after 100 days in a benefit period. Any days beyond that are your responsibility. You would need to pay out of pocket, use other insurance, or explore for Medicaid if you may have access to. Discuss payment options with the facility's billing department before you reach day 100.

Does Medicare Part B cover doctor visits to a skilled nursing facility?

Yes. Part B covers visits from your doctor or any specialist who comes to see you in the facility. You pay Part B's standard coinsurance (usually 20% after your deductible). The facility will bill Part B directly, and you may receive a bill for your share later.