Medicare covers rehabilitation for a limited time after a hospital stay, not indefinitely

Medicare Part A pays for inpatient rehabilitation in a skilled nursing facility (SNF) for up to 100 days per benefit period, but only if you meet specific conditions. You must have been admitted to a hospital for at least three consecutive days, then transferred to a Medicare-certified SNF within 30 days. The facility must provide skilled nursing or rehabilitation services — not just custodial care. After day 100, Medicare stops paying, and you become responsible for all costs.

The length of your actual stay depends on your progress and medical need, not on the 100-day limit itself. Medicare reviews your case regularly to determine whether you still require skilled care. If a doctor determines you no longer need daily skilled nursing or therapy, Medicare can end coverage before day 100. Conversely, if you continue to improve and need skilled services, you can stay the full 100 days.

Key Takeaways

  • Medicare Part A covers up to 100 days in a skilled nursing facility per benefit period, but only after a three-day hospital stay.
  • You pay nothing for days 1–20, then $200 per day (in 2024) for days 21–100, with the amount adjusted yearly.
  • Medicare can end coverage before day 100 if you stop making progress or no longer need skilled care, as determined by the facility's medical team.
  • Outpatient rehabilitation (physical therapy, occupational therapy) is covered under Part B with a copay, but has no day limit — only a medical necessity requirement.
  • If you need care beyond 100 days, you must pay out of pocket, use private insurance, or explore Medicaid if you meet income limits.

The three-day hospital stay requirement and benefit periods

You cannot jump directly from home to a skilled nursing facility and have Medicare pay. You must first be admitted to a hospital as an inpatient (not observation status) for at least three consecutive calendar days. The three days include the day you are admitted but not the day you are discharged. After discharge, you have 30 days to enter a Medicare-certified SNF for Medicare to cover it under the same benefit period.

A benefit period begins the day you enter the hospital and ends 60 days after you leave the SNF. If you return to the hospital during that 60-day window, you do not start a new benefit period — you continue the same one. Once 60 days pass after SNF discharge with no hospital readmission, a new benefit period begins. This matters because each benefit period gives you a fresh 100 days of SNF coverage.

What you pay: coinsurance on days 21 through 100

Days 1 through 20 in a skilled nursing facility cost you nothing under Medicare Part A — the program covers 100 percent. Starting on day 21, you pay a daily coinsurance amount. In 2024, that amount is $200 per day. The coinsurance amount changes each year based on the hospital deductible, so check the current year's figure with your SNF or Medicare before admission.

After day 100, Medicare pays nothing. You are responsible for the full cost of the facility, which typically ranges from $300 to $500 per day or more, depending on location and level of care. Some people have supplemental insurance (Medigap) that covers part or all of the coinsurance on days 21–100. If you have Medicaid as well as Medicare, Medicaid may cover costs Medicare does not. Check your policy or call your insurance company before entering a facility.

How Medicare decides when to stop paying

Medicare does not automatically pay for all 100 days. A doctor at the SNF must certify that you need skilled nursing care or rehabilitation services. Skilled care means services that require a licensed nurse or therapist — wound care, medication management, physical therapy, occupational therapy, or speech therapy. If you only need help with daily activities like bathing or eating, that is custodial care, and Medicare does not cover it.

The facility's medical team reviews your progress every few days. If your condition stabilizes and you no longer need daily skilled services, the doctor can discharge you from Medicare-covered care even if you are still in the building. You may stay in the facility as a private-pay resident, but Medicare stops paying. This can happen on day 15, day 50, or any point before day 100. The facility must notify you in writing before this happens and explain your right to appeal.

Outpatient rehabilitation has no day limit but requires medical necessity

If you receive physical therapy, occupational therapy, or speech therapy as an outpatient (at a clinic, hospital, or your home), Medicare Part B covers it with no specific day limit. You pay 20 percent coinsurance after you meet your Part B deductible. However, Medicare requires that a doctor order the therapy and that it be medically necessary — meaning it is reasonable and necessary to treat your condition.

In practice, Medicare reviews outpatient therapy claims and may deny or limit coverage if the therapy does not show measurable progress toward a functional goal. Therapists must document improvement regularly. If you plateau or therapy becomes maintenance rather than rehabilitative, Medicare may stop paying. There is no automatic cutoff like the 100-day SNF limit, but there is a medical necessity gate that applies throughout.

What happens when Medicare coverage ends

When you reach day 100 in a skilled nursing facility or when Medicare determines you no longer need skilled care, the facility must give you written notice. The notice explains that Medicare is ending coverage and tells you what you owe. From that point forward, you pay the facility's full daily rate out of pocket unless you have another source of payment.

If you cannot afford private pay, ask the facility's social worker about Medicaid. Some states cover long-term care in a nursing facility for people with low income and assets, even if they do not meet Medicaid rules for other services. The process takes time, so start the conversation before your Medicare coverage ends. You may also ask about payment plans or whether the facility offers reduced rates for uninsured residents, though this is not common.

Returning to the hospital and starting a new benefit period

If you are readmitted to the hospital while still in a skilled nursing facility, you remain in the same benefit period. Your 100-day SNF clock does not reset. However, if you are discharged from the SNF and then readmitted to the hospital at least 60 days later, a new benefit period begins, and you get a fresh 100 days of SNF coverage (assuming you meet the three-day hospital stay rule again).

Some people cycle between hospital and SNF multiple times in a year. Each cycle within the same benefit period uses up days from your 100-day allotment. Once you exhaust 100 days in a benefit period, you must wait for a new benefit period to begin — which requires a 60-day break from SNF care. Plan ahead with your doctor and social worker if you anticipate needing extended rehabilitation.

Frequently Asked Questions

Can I extend my stay beyond 100 days if I am still improving?

No. Once you reach day 100 in a benefit period, Medicare coverage ends regardless of your progress. If you need continued care, you must pay privately, use Medicaid if you may have access to, or explore other funding sources. Some facilities offer reduced rates or payment plans for residents who cannot afford full cost.

Does observation status in the hospital count toward the three-day requirement?

No. You must be admitted as an inpatient, not placed on observation status. Ask your hospital whether you are an inpatient or on observation before you are discharged. If you are on observation, those days do not count, and you will not meet the three-day requirement for SNF coverage.

What if my doctor says I need more therapy but Medicare stops paying?

Medicare coverage is based on medical necessity and skilled care requirements, not on what a doctor prefers. If you disagree with Medicare's decision to end coverage, you have the right to appeal. The facility's social worker or patient advocate can help you file an appeal and explain the process.

Do I need to choose between inpatient rehabilitation and a skilled nursing facility?

No. An inpatient rehabilitation facility (IRF) and a skilled nursing facility (SNF) are different settings, but both are covered under Part A with the same 100-day limit per benefit period. An IRF is more intensive and typically for people recovering from stroke or major surgery. An SNF provides skilled nursing and therapy at a lower intensity. Your doctor recommends which setting fits your needs.

If I have a Medigap plan, does it cover the coinsurance on days 21–100?

Most Medigap plans cover some or all of the daily coinsurance in a skilled nursing facility. Check your plan documents or call your insurance company to confirm what your plan covers. Plans vary, so do not assume coverage without checking.