Medicare covers skilled nursing care only when a doctor orders it for a specific medical reason, and only in a facility certified by Medicare — not in your home or in assisted living

Skilled nursing care means hands-on medical or nursing work that requires a licensed nurse or therapist to do it safely. Medicare Part A pays for it in a skilled nursing facility (SNF) — a building separate from a hospital, though sometimes attached to one. The key word is skilled: if you need help with daily tasks like bathing or dressing, that is custodial care, and Medicare does not cover it. If you need wound care, IV medication, catheter management, or physical therapy after a hospital stay, that is skilled care, and Medicare may cover it.

The most common path to skilled nursing coverage is a hospital stay of at least three days, followed by admission to a Medicare-certified SNF within 30 days. You must be admitted as an inpatient to the hospital — observation status does not count. The hospital discharge planner will tell you whether you meet the three-day rule and will help arrange the SNF transfer. If you go directly to a SNF from home or from an outpatient procedure, Medicare will not cover it, even if a doctor thinks you need nursing care.

Key Takeaways

  • Medicare covers skilled nursing only in a Medicare-certified facility, only after a may have access to hospital stay of at least three days as an inpatient, and only within 30 days of hospital discharge.
  • Skilled care means medical or nursing tasks — wound care, IV therapy, physical therapy, catheter management — not help with bathing, dressing, or eating.
  • You pay a copay for days 1–20 (nothing in 2024, but this varies by year), and a daily copay for days 21–100; Medicare covers nothing after day 100 in a benefit period.
  • The SNF must be Medicare-certified; your doctor cannot order skilled nursing in an assisted living facility or in your home and have Medicare pay for it.
  • If you are admitted to the SNF as an observation patient rather than an inpatient, the three-day hospital stay does not count, and you will owe the full cost.

The Three-Day Hospital Stay Rule

You must spend at least three consecutive days in a hospital as an inpatient before Medicare will cover a SNF stay. The three days include the day you are admitted and the day you are discharged, but not the discharge day itself if you leave before midnight. Observation status — a common designation for patients who are being monitored but not formally admitted — does not count. Many people spend three or more days in the hospital under observation and then assume Medicare will cover SNF care; it will not.

Ask the hospital staff directly: "Am I admitted as an inpatient, or am I on observation status?" If you are unsure, request the hospital's notice of observation status or inpatient status in writing. This document matters because it determines whether the three-day rule is met. If you are on observation and believe you should have been admitted as an inpatient, you can file an appeal with the hospital's patient advocate or with Medicare directly, but this takes time and does not speed up SNF coverage.

The hospital discharge planner will confirm the three-day requirement and arrange the SNF transfer if you meet it. You must be admitted to the SNF within 30 days of leaving the hospital. If you go home first and then decide you need SNF care weeks later, Medicare will not cover it, even if your doctor orders it.

What Counts as Skilled Nursing Care

Skilled nursing care is medical or nursing work that requires a licensed professional — a registered nurse (RN), licensed practical nurse (LPN), or licensed therapist — to perform it safely and correctly. Examples include wound care (dressing changes, monitoring for infection), intravenous (IV) medication or nutrition, catheter insertion and management, medication administration when the patient cannot self-administer, physical therapy after surgery or stroke, occupational therapy to regain function, and speech therapy for swallowing or speech problems.

Custodial care — help with bathing, dressing, toileting, eating, and moving around — is not skilled care, even if you cannot do these things yourself. If the SNF is providing only custodial care, Medicare does not cover it. However, if you need skilled care and also need custodial help, the SNF provides both, and Medicare covers the skilled portion. The SNF bills Medicare for the skilled services and may bill you or another payer (Medicaid, supplemental insurance, or out-of-pocket) for the custodial portion.

The SNF must document that skilled care is medically necessary — that is, that you cannot safely recover without it. A doctor's order alone is not enough; the SNF's nursing assessment must show that skilled intervention is required. If Medicare reviews the claim and decides the care was custodial, not skilled, it will deny payment, and you will owe the bill.

Medicare-Certified Facilities Only

Medicare covers skilled nursing only in a facility that holds a current Medicare certification. This is a formal designation; the facility must meet federal standards for staffing, equipment, infection control, and record-keeping. Most SNFs are certified, but not all. Assisted living facilities, memory care units, and independent living communities are almost never Medicare-certified, even if they employ nurses on staff.

Before you or your hospital discharge planner chooses a SNF, confirm that it is Medicare-certified. You can check the Medicare Care Compare tool on Medicare.gov, call the facility directly and ask, or call your state's survey agency (usually the Department of Health). If you are admitted to a non-certified facility, Medicare will not cover it, and you will owe the full cost from day one.

Some facilities are certified for some services but not others. For example, a facility might be certified for skilled nursing but not for rehabilitation therapy. Ask the facility what services are covered under its Medicare certification. If the SNF is certified but the specific service you need is not, Medicare will not cover that service.

How Much Medicare Pays and What You Owe

Medicare Part A covers the full cost of SNF care for days 1 through 20 of each benefit period, with no copay (as of 2024, though this amount can change yearly). For days 21 through 100, you pay a daily copay — currently $200 per day in 2024, but this amount is adjusted each year. Medicare covers nothing after day 100 in a benefit period.

A benefit period begins the day you are admitted to the hospital and ends 60 days after you leave the hospital or SNF, whichever is later. If you are discharged from the SNF, go home for 60 days, and then are readmitted to the hospital, a new benefit period starts, and your SNF days reset to zero. This means you could potentially use another 100 days of SNF coverage in the new benefit period.

You are responsible for any charges above what Medicare allows. If the SNF charges more than the Medicare rate, you do not owe the difference — the facility must accept the Medicare payment as full payment for the skilled portion. However, if the SNF provides services that are not covered (such as private-duty nursing or certain therapies), you may be billed for those separately. Ask the SNF in writing what charges, if any, you will owe beyond the Medicare copay.

When Medicare Stops Paying

Medicare stops paying for SNF care when one of three things happens: you no longer need skilled care, you have used 100 days in the benefit period, or your condition no longer improves with the care being provided. The SNF must document your progress toward recovery or toward a specific functional goal — such as regaining the ability to walk, managing a wound independently, or tolerating oral nutrition instead of a feeding tube.

If your progress plateaus or you are not making measurable gains, the SNF may determine that skilled care is no longer medically necessary and discharge you. This is called a discharge notice, and the SNF must give you written notice at least two days before the discharge date. You have the right to appeal if you believe you still need skilled care. Contact your state's long-term care ombudsman or call Medicare at 1-800-MEDICARE to file an appeal.

Some people remain in the SNF after Medicare stops paying and pay out-of-pocket or with Medicaid (if they are Medicaid-may be able to access). Others go home with home health services, which Medicare may cover if a doctor orders it and you are homebound. Ask the SNF discharge planner about your options before the discharge date.

Observation Status and Why It Matters

Observation status is a hospital designation that looks like an inpatient stay but does not count toward the three-day requirement for SNF coverage. Hospitals use observation status for patients who need monitoring and testing but are expected to be discharged within 24 hours. In practice, many observation patients stay two or three days and then are discharged or admitted as inpatients.

If you are discharged from the hospital on observation status and then admitted to a SNF, Medicare will not cover the SNF stay because the three-day inpatient requirement was not met. You will receive a bill from the SNF for the full cost. This is a common source of surprise bills. If you believe you should have been admitted as an inpatient instead of placed on observation, you can appeal to the hospital's patient advocate or file a formal appeal with Medicare, but this process takes weeks and does not retroactively cover the SNF bill.

To protect yourself, ask the hospital staff on day one: "Am I an inpatient or on observation status?" If you are on observation and your stay extends beyond 24 hours, ask again. If you are discharged on observation and then need SNF care, ask the hospital discharge planner whether you meet the three-day inpatient requirement before going to the SNF.

Frequently Asked Questions

Can Medicare cover skilled nursing care in my home?

No. Medicare covers skilled nursing only in a Medicare-certified SNF. If you need skilled care at home, you may be covered under Medicare home health services, but that is a different program with different rules. You must be homebound, a doctor must order it, and the care must be intermittent, not daily. Ask your doctor whether home health is an option for you.

What if I need skilled nursing care but did not have a three-day hospital stay?

Medicare will not cover SNF care without the three-day inpatient hospital stay. If you need skilled care and did not meet this requirement, you will owe the full SNF cost out-of-pocket, or you may be covered by Medicaid if you are Medicaid-may be able to access. Some SNFs offer private-pay skilled nursing for people who do not may have access to for Medicare coverage.

Can I choose any SNF, or does it have to be near the hospital?

You can choose any Medicare-certified SNF, even one far from the hospital, but you must be admitted within 30 days of hospital discharge. The hospital discharge planner can help you find options, but you have the right to choose. Call the SNF directly to confirm it is Medicare-certified and has an available bed before the hospital arranges the transfer.

What happens if I improve quickly and no longer need skilled care?

The SNF will discharge you when your doctor and the SNF's care team determine that you no longer need skilled nursing care. You will receive a discharge notice, usually with at least two days' notice. You can then go home, to assisted living, or to another setting. Medicare stops paying once skilled care is no longer medically necessary, even if you have days remaining in your 100-day limit.

Do I have to pay the copay if Medicare denies the SNF claim?

If Medicare denies the claim because the care was not skilled or because you did not meet the three-day requirement, you are responsible for the full bill. You have the right to appeal the denial. Contact the SNF's billing department or call Medicare at 1-800-MEDICARE to understand why the claim was denied and what your appeal options are.