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, be discharged to the SNF within 30 days, and need daily skilled nursing or therapy services that cannot be done at home. The facility itself must be Medicare-certified. After 100 days in a single benefit period, Medicare stops paying, though you may be responsible for costs or may have other coverage.

The length of your actual stay depends on your recovery progress, not on the 100-day limit alone. Medicare reviews your case regularly to determine whether you still need inpatient rehabilitation. If you improve quickly and can safely return home, your stay may end in two weeks. If your recovery is slower, you could stay closer to the full 100 days. Your doctor and the SNF care team decide when you no longer need daily skilled care.

Key Takeaways

  • Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period if you meet hospital admission and timing requirements.
  • You pay nothing for days 1–20, a daily copay of $194.50 (in 2024) for days 21–100, and all costs after day 100.
  • Your actual length of stay depends on your recovery progress and whether you still need skilled nursing or therapy services daily.
  • A benefit period ends 60 days after you leave the SNF, and a new 100-day window begins if you return to the hospital and are readmitted to an SNF.
  • Outpatient rehabilitation, home health, and other services have different coverage rules and may continue after your SNF stay ends.

What counts as a may have access to hospital stay

You must spend at least three consecutive days as an inpatient in a hospital before Medicare will cover a SNF stay. The three days must be for active treatment, not observation. Many people are admitted to a hospital as "observation" patients rather than inpatients, and observation days do not count toward the three-day requirement. Ask the hospital directly whether you are an inpatient or observation patient—this distinction affects whether your SNF care is covered.

You must be admitted to the SNF within 30 days of leaving the hospital. If you go home first and then need rehabilitation later, that later stay is not covered under the same hospital admission. The SNF must also be Medicare-certified and provide the type of care you need. Not all nursing homes are certified for skilled rehabilitation; some are certified only for long-term custodial care, which Medicare does not cover.

How the 100-day limit and copay structure work

The 100 days are counted within a single benefit period. A benefit period begins the day you enter the hospital and ends 60 days after you leave the SNF. If you are readmitted to the hospital during that 60-day window and then go to an SNF again, those additional days count toward the same 100-day limit. Once 60 days pass after you leave the SNF, a new benefit period begins, and you get a fresh 100 days if you meet the hospital admission requirement again.

Your out-of-pocket costs rise as your stay continues. For days 1 through 20, Medicare covers all approved charges and you pay nothing. Starting on day 21, you pay a daily copay (set at $194.50 in 2024, though this amount changes yearly). This copay continues through day 100. After day 100 in the same benefit period, Medicare pays nothing, and you are responsible for the full cost unless you have supplemental insurance or Medicaid coverage.

How Medicare decides when your stay should end

Medicare does not automatically pay for the full 100 days. A utilization review nurse employed by Medicare or a Medicare contractor reviews your medical record regularly—often within the first few days and then periodically—to confirm you still need inpatient rehabilitation. The review focuses on whether you require daily skilled nursing care (such as wound care, medication management, or monitoring) or daily therapy (physical, occupational, or speech therapy) that cannot safely be provided at home or in an outpatient setting.

If the reviewer determines you no longer meet medical necessity for inpatient care, Medicare may deny payment for future days. You will receive a notice called a "Notice of Non-Coverage" before this happens, which explains why Medicare believes your stay should end and what you can do if you disagree. If you receive this notice, you have the right to request a review, and you cannot be charged for days you stay while that review is pending.

What happens when your SNF coverage ends

When your 100 days are exhausted or Medicare determines you no longer need inpatient rehabilitation, your SNF stay ends from Medicare's perspective. You have several options depending on your recovery and needs. If you can manage at home with help from family or paid caregivers, you may be discharged home. If you still need therapy or nursing support but can receive it without staying overnight, you may transition to outpatient therapy, home health services, or an adult day program.

Some people move to a long-term care facility or assisted living if they cannot live independently. These settings are not covered by Medicare Part A, though Medicaid may cover them if you meet income and asset limits. Your SNF social worker or discharge planner can help you understand your options and what each setting costs. Ask about this transition plan well before your 100 days end so you have time to arrange the next step.

Outpatient rehabilitation and home health after SNF discharge

After you leave the SNF, Medicare may cover outpatient physical therapy, occupational therapy, or speech therapy if your doctor orders it and you continue to improve. Outpatient therapy is covered under Medicare Part B and has different limits: Medicare covers up to 60 visits per year for physical therapy and occupational therapy combined, and up to 60 visits per year for speech therapy, though these limits can be exceeded if your doctor documents medical necessity. You pay 20 percent of the approved amount after you meet your Part B deductible.

Home health services—nursing visits, therapy, and aide services—may also be covered if you are homebound (unable to leave home without significant effort or information) and your doctor orders the care. Home health does not have a day limit like SNF care does; instead, Medicare covers visits as long as you remain homebound and need skilled care. Home health is covered at no cost to you beyond your Part B deductible. These services can extend your recovery period well beyond your SNF discharge date.

What to ask your doctor and SNF care team

Before or shortly after admission to an SNF, ask your doctor and the SNF team these questions: "How long do you expect my rehabilitation to take?" "What specific goals are we working toward?" "How will you measure my progress?" "What happens if I reach a plateau?" "When will Medicare likely stop covering my stay?" "What are my options after SNF discharge?" "Will I need outpatient therapy or home health, and how do I arrange that?"

Ask the SNF billing department to explain your copay responsibility and confirm that the facility is Medicare-certified. Request a copy of your Notice of Non-Coverage when ready if you receive one, and ask the SNF social worker to explain what it means and what your appeal options are. If you disagree with a decision to end your coverage, you have the right to request a peer review, and you should do so within the timeframe stated in the notice.

Frequently Asked Questions

Can I stay in a SNF longer than 100 days if I am still improving?

No. Once you reach 100 days in a benefit period, Medicare stops paying, even if you are still making progress. You would need to pay out of pocket, have supplemental insurance, or may have access to for Medicaid. Some people return home and continue therapy as outpatients, which may be more affordable.

What is the difference between observation and inpatient status, and why does it matter?

Inpatient status means you are admitted to the hospital for active treatment; observation status means you are being monitored but not formally admitted. Only inpatient days count toward the three-day requirement for SNF coverage. Ask the hospital to clarify your status in writing, as it directly affects whether your SNF stay is covered.

If I leave the SNF and come back later, do I get another 100 days?

Only if you return to the hospital for at least three consecutive days first and are readmitted to the SNF within 30 days. If 60 days have passed since you left the SNF, a new benefit period begins and you get a fresh 100 days. If you return within 60 days, additional days count toward your original 100-day limit.

What does it mean if I get a Notice of Non-Coverage?

It means Medicare believes you no longer need inpatient rehabilitation and will stop paying for your SNF stay. You have the right to request a peer review, and you cannot be charged for days you stay while that review is happening. Contact your SNF social worker or patient advocate when ready if you receive this notice.

Will Medicare cover therapy after I go home?

Yes, if your doctor orders it. Outpatient therapy is covered under Part B with visit limits, and home health is covered if you are homebound. Both have different rules than SNF care, so ask your discharge planner what services are recommended and how to arrange them before you leave.