What Medicare Covers in a Skilled Nursing Facility

Medicare Part A covers skilled nursing facility care after a hospital stay

Yes, Medicare Part A pays for skilled nursing facility (SNF) care, but only under 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 facility must provide skilled care — meaning a nurse or therapist must deliver the care, not just a caregiver. Physical therapy, occupational therapy, and speech therapy all count as skilled care. Custodial care, like help with bathing or dressing alone, does not.

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. If you return to the hospital and then to an SNF again, a new benefit period begins, and you get another 100 days.

Key Takeaways

You must spend at least three consecutive days in a hospital before Medicare will pay for SNF care.
Medicare Part A covers the first 20 days at no cost to you, then days 21 through 100 with a daily copay that changes each year.
The SNF must be Medicare-approved and must provide skilled nursing or therapy — not just help with daily living tasks.
If you do not improve or no longer need skilled care, Medicare can stop paying even if you have not used all 100 days.

How much Medicare pays and what you pay

Medicare Part A covers 100 percent of the cost for the first 20 days you spend in a Medicare-approved SNF. Starting on day 21, you pay a daily copay. The copay amount changes each year — in 2024 it was $200 per day, but you should confirm the current amount with your SNF or by calling Medicare at 1-800-MEDICARE.

After day 100 in a benefit period, Medicare stops paying. You then pay the full cost of the facility out of pocket, unless you have a supplemental insurance policy (Medigap) or Medicaid that covers SNF care. Some Medigap plans cover part or all of the daily copay for days 21 through 100.

The copay covers room, board, meals, nursing care, therapy, and most medications given in the facility. It does not cover private-duty nurses, phone calls, or items the facility considers personal (like a television in your room).

What counts as a three-day hospital stay

The three days must be consecutive days as an inpatient in a hospital — not an emergency room visit or observation status. Observation status is different from inpatient admission. If you were in observation, those days do not count toward the three-day requirement, even if you spent them in a hospital bed.

Ask the hospital before you are discharged whether you were admitted as an inpatient or placed in observation. If you are unsure, call Medicare at 1-800-MEDICARE and give them your hospital admission date and hospital name. They can tell you your status. This matters because if you were in observation, you will not meet the requirement for Medicare to pay for SNF care.

When Medicare stops paying for SNF care

Medicare can stop paying before you reach 100 days if a doctor determines you no longer need skilled care. This happens when your condition has improved enough that you no longer require daily nursing assessment or therapy. The SNF must notify you in writing before they stop billing Medicare, and you have the right to appeal the decision.

If you disagree with the decision to stop coverage, you can request a Quality Improvement Organization (QIO) review. The QIO is an independent group that reviews whether the SNF's decision was correct. You have until midnight of the day you receive the notice to request this review, and you can stay in the facility while the review happens without paying if you request it by that important date.

SNF care that Medicare does not cover

Medicare Part A does not pay for custodial care — help with bathing, dressing, eating, or toileting when that is the only care you need. It also does not cover care in facilities that are not Medicare-approved, or care that is not medically necessary.

If you need long-term custodial care in a nursing home, Medicaid may pay, but Medicaid rules vary by state. Some states cover nursing home care for people with limited income and assets; others have waiting lists or stricter rules. Contact your state Medicaid office or call 1-800-MEDICARE to learn what is available where you live.

How to find a Medicare-approved skilled nursing facility

Your hospital discharge planner can give you a list of Medicare-approved SNFs in your area. You can also search the Medicare Care Compare tool at Medicare.gov — type in your zip code and the tool shows you nearby facilities, their inspection records, staffing levels, and what other patients have reported about their experience.

Before you are discharged, ask the hospital which SNF has an open bed and whether your insurance is accepted. If you have a preference, tell the discharge planner early — popular facilities may have a wait. You have the right to choose the facility, but Medicare will only pay if it is approved and if you meet the three-day hospital stay requirement.

What happens after you leave the SNF

When you leave the SNF, Medicare Part A coverage for that stay ends. If you need ongoing therapy or care at home, you may be covered under Medicare Part A home health services if a doctor orders it and you are homebound. Home health coverage has different rules and time limits than SNF coverage.

If you need to return to the hospital and then to an SNF again, a new benefit period begins, and you get another 100 days of SNF coverage. However, if you leave the SNF, go home, and then need SNF care again within 60 days, you are still in the same benefit period, so your 100 days do not reset.

Frequently Asked Questions

Do I have to go to a specific SNF, or can I choose?

You can choose any Medicare-approved SNF that has an open bed and accepts your insurance. The hospital discharge planner can help you find options, but the choice is yours. If the facility you want is full, you may need to go elsewhere first and transfer later.

What if I was in the hospital for observation, not as an inpatient?

Observation days do not count toward the three-day requirement. Medicare will not pay for SNF care unless you were admitted as an inpatient for at least three consecutive days. You can appeal the observation status decision if you believe it was wrong — ask the hospital for the QIO contact information.

Can Medicare pay for SNF care if I did not come from a hospital?

No. Medicare Part A SNF coverage requires a hospital stay of at least three consecutive days as an inpatient first. If you need nursing home care without a recent hospital stay, you would need to explore Medicaid or pay out of pocket, depending on your state and finances.

What if I run out of my 100 days before I am ready to leave?

Once your 100 days are used in a benefit period, Medicare stops paying. You then pay the full facility cost out of pocket unless you have Medicaid or a Medigap plan that covers SNF care. Talk to the SNF social worker about payment options and whether you might be discharged to home care instead.

Does Medicare Part B or Part D cover anything in the SNF?

Part B covers doctor visits and some outpatient services, but not the SNF room or board. Part D (prescription drug coverage) does not explore to drugs given to you in the facility — those are covered under Part A. The SNF bills Part A for all facility-based care and medications.

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.