Medicare covers rehab in a skilled nursing facility for up to 100 days per benefit period, but the amount you pay changes after day 20, and most people do not stay the full 100 days.

Your first 20 days in a Medicare-covered skilled nursing facility cost you nothing — Medicare Part A pays the full bill. From day 21 through day 100, you pay a daily coinsurance amount (currently $194.50 per day in 2024, though this changes yearly), and Medicare covers the rest. After day 100, you pay all costs yourself until your benefit period ends.

The catch is that this 100-day window resets only when you have been out of a hospital or skilled nursing facility for 60 days in a row. If you return to the hospital and then go back to rehab within that 60-day window, your new stay counts against the same 100 days — you do not get a fresh 100 days.

How long you actually stay depends on your recovery progress, not on the calendar. Your doctor and the facility's care team decide when you are ready to go home or move to a different level of care. Medicare will not pay for a day if the facility cannot show that you still need skilled nursing or rehabilitation services.

Key Takeaways

  • Medicare Part A covers all costs for the first 20 days in a skilled nursing facility after a hospital stay of at least 3 days.
  • From day 21 to day 100, you pay a daily coinsurance amount while Medicare covers the rest of the bill.
  • Your 100-day benefit resets only after you have been out of a hospital or skilled nursing facility for 60 consecutive days.
  • The facility must document that you still need skilled care for Medicare to keep paying; recovery progress, not the calendar, determines your discharge date.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs after day 20 may be lower or different.

What counts as a "benefit period" and when it resets

A benefit period starts the day you enter a hospital and ends 60 days after you leave the hospital or skilled nursing facility. During that one benefit period, you have access to 100 days of skilled nursing facility care. The 100 days do not have to be used all at once — you could use 30 days, go home for a month, return to the hospital, and then use another 50 days from the same 100-day pool.

Once you have been home (or in a non-hospital, non-skilled-nursing setting) for 60 days straight, a new benefit period begins. At that point, you get a fresh 100 days. If you go back to the hospital before those 60 days are up, you are still in the same benefit period, and any new skilled nursing stay counts against your remaining days.

This matters because many people assume they get 100 new days every time they enter a facility. They do not. Track your own dates — write down when you left the hospital or facility, and count forward 60 days. That is when your benefit period ends and a new one starts.

Your costs: days 1–20 versus days 21–100

For the first 20 days, you pay nothing if you meet Medicare's requirements. Medicare Part A covers the full cost of the room, meals, nursing care, therapy, and most medications and supplies. You do not need to pay a deductible or coinsurance.

Starting on day 21, you begin paying coinsurance — a fixed daily amount that changes each year. In 2024, that amount is $194.50 per day. You pay this amount for each day you stay from day 21 through day 100. Medicare pays the rest of the facility's bill. After day 100, Medicare stops paying, and you are responsible for the full daily cost of the facility.

If you have a Medigap policy (supplemental insurance), it may cover some or all of your coinsurance after day 20. If you have a Medicare Advantage plan, your costs depend on your specific plan — some cover coinsurance fully, some partially, and some require you to pay it. Check your plan documents or call your plan's customer service line to know your exact cost.

What Medicare requires to keep paying for your stay

Medicare will not pay for a day straightforward because you are in the facility. The facility must document that you need skilled nursing care or skilled rehabilitation services. Skilled care means nursing services that only a licensed nurse can provide — wound care, medication management, catheter care, or monitoring of complex medical conditions. Skilled rehabilitation means therapy (physical, occupational, or speech) that is medically necessary and ordered by a doctor.

Your care team meets regularly to assess whether you still need this level of care. If your condition improves and you no longer need skilled services — for example, if you can manage your medications on your own and no longer need physical therapy — Medicare will not pay for additional days, even if you are still in the facility. The facility must discharge you or move you to a lower level of care (such as assisted living or home care).

You have the right to see your care plan and ask questions about why Medicare is or is not paying. If you disagree with a discharge decision, you can request a review. The facility must give you written notice before they stop billing Medicare, and you have the right to appeal.

What happens when your 100 days run out

When you reach day 101, Medicare Part A stops paying. At that point, you are responsible for the full daily cost of the facility — typically $300 to $500 per day or more, depending on the facility and your location. This is why it is important to plan ahead if you think you might need more than 100 days.

Some people transition to a lower level of care, such as assisted living or home health services, which may be covered under different Medicare rules or by other insurance. Others use private pay, Medicaid (if they meet income limits), or long-term care insurance. Talk to the facility's social worker or discharge planner about your options before day 100 arrives.

If you are still in the facility after day 100 and cannot pay, the facility is required to work with you on a payment plan or help you find other funding sources. They cannot straightforward discharge you onto the street, but they can pursue collection action if you do not pay.

How to prepare for discharge or a longer stay

Before you enter a skilled nursing facility, ask your hospital discharge planner how many days your doctor expects you to need. This is not a may provide — recovery does not always follow a timeline — but it gives you a starting point. If your doctor thinks you might need more than 20 days, start planning early for how you will cover coinsurance costs.

Keep a calendar of your dates. Write down the day you were admitted to the hospital, the day you were admitted to the facility, and count forward 60 days to know when your benefit period ends. Ask the facility's billing department to send you a summary of your days used so far. Do not rely on memory.

Talk to the facility's social worker about discharge planning as soon as you arrive. Ask what the goal is for your recovery, what services you will need at home, and whether home health care or outpatient therapy will be covered. If you think you might need to stay longer than 100 days, explore whether you have long-term care insurance, whether you may have access to for Medicaid, or whether you have family or financial resources to cover private pay.

Frequently Asked Questions

Do I have to stay the full 100 days if Medicare is paying?

No. Your doctor and the facility's care team decide when you are ready to leave based on your recovery. If you no longer need skilled care, Medicare will not pay for additional days, and the facility will discharge you. You cannot stay just because you have days remaining.

What if I go home and then need to go back to the facility within 60 days?

Any new stay within 60 days counts against your remaining days from the same benefit period. If you used 30 days, went home, and returned within 60 days, you would have 70 days left, not 100. After 60 days at home, a new benefit period starts and you get 100 new days.

Does my Medicare Advantage plan cover the coinsurance after day 20?

It depends on your specific plan. Some Medicare Advantage plans cover coinsurance fully, some partially, and some do not cover it at all. Check your plan documents or call your plan's customer service number to find out what you will owe.

What if the facility says I need to leave but I do not think I am ready?

You have the right to request a review. The facility must give you written notice before they stop billing Medicare. You can ask for a detailed explanation of why they believe you no longer need skilled care, and you can appeal the decision. Contact your state's long-term care ombudsman for help if you disagree with the discharge plan.

Can I use my 100 days across multiple facilities?

Yes, as long as you do not go home (or to a non-hospital, non-skilled-nursing setting) for more than 60 days in a row. If you use 40 days at one facility, go home for 30 days, and return to a different facility within 60 days, you have 60 days remaining at the second facility from the same benefit period.