Medicare covers part of skilled nursing care, but only after a hospital stay and only for a limited time

Medicare Part A pays for skilled nursing facility (SNF) care after you have spent at least three consecutive days in a hospital. The facility must be Medicare-certified, and a doctor must order the care as part of your recovery from an acute illness or injury. Medicare does not pay for custodial care — help with daily activities like bathing or dressing — or for long-term residential care.

The coverage works in phases. For the first 20 days, Medicare pays the full cost of your stay. From day 21 through day 100, you pay a daily coinsurance amount (the amount changes each year; in 2024 it is $194.50 per day) and Medicare covers the rest. After day 100 in a benefit period, Medicare stops paying and you are responsible for all costs.

A benefit period begins the day you enter the hospital and ends 60 days after you leave the SNF with no readmission to a hospital or SNF. If you are readmitted to a hospital after leaving the SNF, a new benefit period starts, and your SNF coverage resets.

Key Takeaways

  • Medicare Part A covers skilled nursing care only after a three-day hospital stay, and the facility must be Medicare-certified.
  • Medicare pays all costs for the first 20 days, then you pay a daily coinsurance amount (currently $194.50 per day) from day 21 through day 100.
  • Coverage ends after 100 days in a benefit period, and a new benefit period begins only if you return to the hospital.
  • Medicare does not pay for custodial care or long-term residential nursing home stays.
  • You should verify the facility is Medicare-certified and confirm your hospital stay meets the three-day requirement before admission.

What counts as a three-day hospital stay

The three days must be consecutive and count as inpatient days. A day counts as inpatient if you are formally admitted to the hospital as an inpatient — not if you are in observation status. Observation status is different from inpatient admission, and days spent in observation do not count toward the three-day requirement, even if you are in a hospital bed.

Before you are discharged, ask the hospital to confirm in writing that you were admitted as an inpatient and how many inpatient days you have. If you are unsure whether your stay was inpatient or observation, contact Medicare at 1-800-MEDICARE (1-800-633-4227) and provide your hospital admission date and hospital name. Medicare can tell you how your stay was classified.

What skilled nursing care means under Medicare

Skilled nursing care is medical care that requires a nurse or therapist — not just any care provided in a nursing home. Examples include wound care after surgery, intravenous (IV) medication, physical therapy after a stroke or hip fracture, or management of a complex medical condition. The care must be ordered by a doctor and must be related to the condition that sent you to the hospital.

Custodial care — help with bathing, dressing, toileting, or eating — is not skilled care, even if it is provided by a nurse. If you need only custodial care, Medicare does not pay, and you must pay out of pocket or use Medicaid if you are enrolled in both programs.

A doctor and the SNF's medical team will assess whether your care needs are skilled or custodial. If your condition improves and you no longer need skilled care, Medicare coverage ends even if you are still within the 100-day window. The facility must notify you in writing if they believe you no longer need skilled care.

How much you pay out of pocket

Your costs depend on which days of your stay fall within your coverage window. For days 1 through 20, you pay nothing if you meet the three-day hospital requirement. For days 21 through 100, you pay the daily coinsurance amount. In 2024, that amount is $194.50 per day, but it increases each year.

You are also responsible for any services or supplies that Medicare does not cover — such as phone service, television, or private room upgrades. Ask the SNF for an itemized list of what is and is not covered by Medicare before you arrive.

If you have a Medigap (supplemental insurance) or Medicare Advantage plan, your plan may cover part or all of the coinsurance. Check your plan documents or call your plan to find out what your SNF coinsurance coverage is.

Choosing a Medicare-certified skilled nursing facility

Not all nursing homes are Medicare-certified. Before you are discharged from the hospital, ask the hospital discharge planner which SNFs are Medicare-certified and accept your insurance. You have the right to choose which facility you go to, though your insurance may limit which ones it covers.

You can search for Medicare-certified SNFs on the Medicare Care Compare website at www.medicare.gov/care-compare. The site shows inspection results, staffing levels, and quality measures for each facility. You can also call 1-800-MEDICARE to ask which facilities near you are certified.

Before admission, confirm with the SNF that they accept Medicare and that they have a bed available. Ask them to verify that your hospital stay meets the three-day requirement and that your doctor's orders for skilled care are on file. Getting these details in writing before you arrive prevents delays or denials after you are admitted.

What happens when your Medicare coverage ends

When you reach day 100 of your benefit period, or when the SNF determines you no longer need skilled care, Medicare stops paying. The facility must give you written notice at least two days before coverage ends, explaining why and what your options are.

At that point, you can stay in the facility and pay out of pocket, move to a different facility, or go home. If you cannot afford to stay and have no other options, ask the SNF's social worker about Medicaid coverage or other community resources. Some states cover SNF care under Medicaid for people who meet income and asset limits.

If you believe the SNF ended your coverage too early, you have the right to appeal. You can request a detailed explanation of why skilled care ended and ask for a review. Contact Medicare at 1-800-MEDICARE if you want to challenge the decision.

Medicare Advantage and SNF coverage

If you are enrolled in a Medicare Advantage plan instead of Original Medicare, your SNF coverage may be different. Most Medicare Advantage plans cover SNF care under the same rules as Original Medicare — after a three-day hospital stay, up to 100 days per benefit period — but some plans have stricter limits or require prior approval.

Before you are discharged from the hospital, tell the discharge planner which insurance you have. If you have a Medicare Advantage plan, ask them to contact your plan to confirm that the SNF you are going to is in-network and that your stay is approved. Some plans require the SNF to get approval before you arrive.

Check your Medicare Advantage plan documents or call your plan's customer service number to understand your coinsurance amount and any other out-of-pocket costs you may owe.

Questions to ask before you go to a skilled nursing facility

Before you are discharged from the hospital, write down these questions and ask the discharge planner or SNF to answer them in writing:

  • Is this facility Medicare-certified?
  • Does my insurance cover this facility?
  • How many inpatient days did I spend in the hospital?
  • What skilled care does my doctor order, and for how long?
  • What is my daily coinsurance cost, and how many days of coverage do I have?
  • What services or supplies are not covered by Medicare?
  • When will the facility reassess whether I still need skilled care?
  • What happens if I disagree with the decision to end coverage?

Frequently Asked Questions

Can I go to a skilled nursing facility without a hospital stay first?

No. Medicare Part A covers SNF care only after a three-day inpatient hospital stay. If you need skilled nursing care but have not been hospitalized, Medicare does not pay for it. You would need to pay out of pocket or use Medicaid if you are enrolled in both programs.

What if I am in the hospital for observation instead of as an inpatient?

Observation days do not count toward the three-day requirement. If you are discharged after observation status only, Medicare will not pay for SNF care. Before you leave the hospital, ask in writing whether you were admitted as an inpatient or kept in observation status. If you were in observation, ask the hospital to reconsider your status or contact Medicare to appeal.

Does Medicare pay for a private room in a skilled nursing facility?

Medicare covers a semi-private room (shared with one other patient). If you want a private room, you pay the difference between the semi-private and private room rates out of pocket. The SNF must tell you this cost before you arrive.

What if I need to stay longer than 100 days?

Medicare does not extend coverage beyond 100 days in a benefit period. If you still need skilled care after day 100, you must pay out of pocket, use Medicaid if you may have access to, or explore other payment options. A new benefit period begins only if you return to the hospital for at least three inpatient days.

Can I appeal if Medicare stops paying for my skilled nursing care?

Yes. If you believe the SNF ended your coverage too early or that you still need skilled care, you can request an appeal. The SNF must give you written notice before coverage ends and explain how to appeal. Contact Medicare at 1-800-MEDICARE to file an appeal or ask for a detailed review of the decision.