Medicare Does Cover Skilled Nursing, But Only After a Hospital Stay

Medicare Part A covers skilled nursing facility (SNF) care, but only if you meet specific conditions. You must have been admitted to a hospital for at least three consecutive days, then move directly to a Medicare-approved SNF within 30 days of leaving the hospital. The care must be for a condition related to your hospital stay, and a doctor must order it. If you go to a SNF without a may have access to hospital stay first, Medicare will not pay.

Skilled nursing is different from regular nursing home care. It means a registered nurse or licensed practical nurse provides medical treatment — wound care, physical therapy, medication management, or monitoring after surgery. If you need only help with daily activities like bathing or dressing, that is custodial care, and Medicare does not cover it.

Key Takeaways

  • Medicare Part A covers up to 100 days in a skilled nursing facility per benefit period, but only after a may have access to hospital stay of at least three days.
  • You pay nothing for days 1 through 20, but from day 21 onward you pay a daily coinsurance amount that changes each year.
  • The facility must be Medicare-approved, and your doctor must document that skilled nursing care is medically necessary for your condition.
  • If you stay longer than 100 days in one benefit period, you pay all costs after day 100 unless you have a Medigap or Medicare Advantage plan that covers the gap.

How Many Days Medicare Covers and What You Pay

Medicare Part A covers up to 100 days per benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave the SNF with no readmission. You pay nothing for the first 20 days. From day 21 through day 100, you pay a daily coinsurance amount — this amount is set each year by Medicare and varies. For 2024, the daily coinsurance is $194.50, but confirm the current year's amount with your SNF or Medicare directly.

After day 100, Medicare stops paying entirely. If you need to stay longer, you pay the full cost of the facility unless you have a Medigap policy (supplemental insurance) or a Medicare Advantage plan that covers skilled nursing beyond 100 days. Some plans do; many do not. Check your plan documents or call your plan to know what you are responsible for.

The Three-Day Hospital Stay Requirement

The hospital stay must be at least three consecutive days and must be an inpatient admission — observation stays do not count. This is a common source of confusion. If your hospital records show you were on "observation status" rather than admitted as an inpatient, you do not meet the requirement, even if you spent three or more days in the hospital.

Before you leave the hospital, ask the discharge planner whether you were admitted as an inpatient or placed on observation. If you were on observation and believe it was wrong, you can file an appeal with Medicare, but this takes time. If you need SNF care when ready and your status is unclear, the hospital or SNF social worker can help you understand your options and whether you might be responsible for costs during the dispute.

Finding a Medicare-Approved Skilled Nursing Facility

Not all nursing homes are Medicare-approved. You can search for approved facilities on Medicare.gov using the Care Compare tool, which also shows inspection reports, staffing levels, and quality ratings. When your hospital discharge planner discusses SNF options, confirm that any facility you are considering is on this list.

Some SNFs have limited Medicare beds or may not accept Medicare patients at all. Call ahead to confirm they have a bed available and that they accept your specific insurance (Medicare Part A, or your Medicare Advantage plan if you have one). If the facility is not Medicare-approved or does not accept your coverage, you will pay out of pocket.

What Happens If You Do Not Meet the Requirements

If you need nursing home care but do not have a may have access to hospital stay, Medicare Part A will not pay. You may be able to pay privately, or you may be able to use Medicaid if you meet income and asset limits — Medicaid rules vary by state. Some Medicare Advantage plans cover limited SNF stays without the hospital requirement, so check your plan documents.

If you are on Medicare Part B only (without Part A), SNF care is not covered. Part B covers doctor visits and outpatient services, not facility stays. If you do not have Part A, you can enroll during the General Enrollment Period (January 1 through March 31 each year), though you may owe a higher premium if you did not sign up when first may be able to access.

Medicare Advantage Plans and Skilled Nursing Coverage

If you have a Medicare Advantage plan (Part C), your SNF coverage works differently than Original Medicare. Most Medicare Advantage plans cover the same 100 days as Part A, but some cover fewer days or charge different copays. A few plans cover SNF stays without the three-day hospital stay requirement, though this is less common.

Before you need SNF care, review your Medicare Advantage plan's summary of coverage or call the plan to understand your SNF benefits. If you are hospitalized and need SNF care, tell the discharge planner which plan you have so they can verify coverage and help you find an in-network facility if your plan requires it.

Medigap and Skilled Nursing Coverage

Medigap policies (supplemental insurance) can help cover the daily coinsurance you pay from day 21 through day 100. Some Medigap plans also cover a portion of costs after day 100, though coverage varies by plan type. If you have Medigap, bring your policy documents to the SNF so they know what costs you are responsible for.

If you do not have Medigap and you reach day 100, you become responsible for all SNF costs. This can add up quickly — nursing home costs vary widely by location and facility type, but can range from several thousand to over ten thousand dollars per month. If you think you might need long-term SNF care, discuss coverage gaps with your insurance agent or call 1-800-MEDICARE to understand your options.

Frequently Asked Questions

Does an observation stay at the hospital count toward the three-day requirement?

No. Only inpatient admissions count. Observation status is outpatient care, even if you stay overnight. If you were on observation and need SNF care, Medicare Part A will not cover it. You can appeal if you believe the observation status was incorrect, but this process takes time.

What if I need SNF care but was never hospitalized?

Medicare Part A will not cover it. You would need to pay privately, explore Medicaid (which has different rules), or check whether your Medicare Advantage plan covers SNF without a hospital stay. Some plans do, though most require the three-day hospital stay.

Can I choose any nursing home, or does it have to be in my insurance network?

With Original Medicare (Part A and B), you can choose any Medicare-approved facility. With Medicare Advantage, you may be required to use in-network facilities or pay more if you go out of network. Check your plan documents or call your plan before choosing a facility.

What happens to my Medicare coverage if I stay in a SNF longer than 100 days?

After day 100 in one benefit period, Medicare Part A stops paying. You pay all costs unless you have Medigap or a Medicare Advantage plan that covers extended SNF stays. A new benefit period begins 60 days after you leave the SNF, which would reset your 100-day coverage.

Do I have to go to a SNF right after leaving the hospital?

You must enter the SNF within 30 days of leaving the hospital for Medicare to cover it. The care must also be for a condition related to your hospital stay. If you wait longer than 30 days or need SNF care for an unrelated condition, Medicare will not pay.