Medicare covers a limited number of days in a rehabilitation facility, and when those days run out, you stop receiving Medicare payment

Medicare Part A pays for up to 100 days in a skilled nursing facility or inpatient rehabilitation center per benefit period, but only if you meet specific conditions. The first 20 days are fully covered. Days 21 through 100 require a daily copayment (called coinsurance) that you pay out of pocket. Once you reach day 101, Medicare stops paying entirely, and you become responsible for all costs — typically $200 to $400 per day or more, depending on the facility.

When your Medicare coverage ends, you have several options: you can stay at the facility and pay privately, move to a less intensive care setting, return home with outpatient therapy, or explore other payment sources. The key is understanding what happens before day 100 arrives so you can plan ahead with your care team, family, and the facility's social worker or discharge planner.

Key Takeaways

  • Medicare Part A covers up to 100 days of skilled nursing or rehabilitation care per benefit period, with full coverage for the first 20 days and coinsurance required for days 21–100.
  • After day 100, you pay the full facility cost yourself unless you have supplemental insurance, Medicaid, or other coverage that picks up where Medicare stops.
  • The facility's social worker or discharge planner can tell you exactly which day your Medicare coverage ends and what your options are at that point.
  • Some people transition to outpatient therapy, home health care, or assisted living when inpatient rehab coverage ends, depending on their recovery and needs.
  • Medicaid may cover continued facility care if you meet income and asset limits, but rules vary significantly by state.

How Medicare counts your 100 days

Your 100-day benefit period starts the day you are admitted to the skilled nursing facility or inpatient rehabilitation center as an inpatient. Medicare counts calendar days, not business days, so weekends and holidays count toward your total. The clock does not reset if you leave for a doctor's appointment or outpatient therapy and return — those days still count against your 100.

If you are discharged and then readmitted to a facility more than 60 days later, a new benefit period begins and you get another 100 days. However, if you are readmitted within 60 days, you continue using days from your current benefit period. Ask the facility's billing department or social worker to confirm which day your coverage ends — this is not something to guess about.

What you owe when coverage runs out

For days 1 through 20, Medicare pays 100 percent of the cost (after you meet your Part A deductible for the benefit period). Starting on day 21, you pay a coinsurance amount each day — in 2024, this is $200 per day, though the amount changes yearly. Medicare pays the rest. You are responsible for this coinsurance even if you cannot afford it; it does not disappear if you do not pay.

Once you reach day 101, you owe the entire daily rate. Skilled nursing facilities typically charge $200 to $400 per day, and inpatient rehabilitation centers often cost $500 to $1,000 per day or more, depending on location and the level of care. If you cannot pay, the facility may discharge you, place you on a payment plan, or refer you to financial information programs. Some facilities will not admit you or will discharge you if they believe you cannot pay after Medicare coverage ends.

Medicaid coverage after Medicare ends

Medicaid is a joint federal and state program that covers long-term care facility stays for people with low income and limited assets. Unlike Medicare, Medicaid has no day limit — it can cover facility care indefinitely if you remain may be able to access. However, Medicaid rules vary by state, and you must meet strict income and asset thresholds to may have access to.

In most states, your countable assets must be below $2,000 (for an individual) to may have access to for Medicaid long-term care coverage. Your home, one vehicle, and some personal items do not count, but savings, investments, and other property do. Your monthly income limit also varies by state. If you are nearing the end of your Medicare coverage and think Medicaid might help, contact your state Medicaid office or ask the facility's social worker to screen you for coverage. The process can take weeks, so start early.

Some states have programs that help people "spend down" assets to reach Medicaid limits through legal planning, though these rules are complex and require professional guidance. A social worker or elder law attorney can explain what is available in your state.

Transitioning to outpatient therapy or home care

If you still need therapy but no longer need 24-hour facility care, you may be able to move to outpatient physical therapy, occupational therapy, or speech therapy. Medicare Part B covers outpatient therapy with a copayment, though there are annual limits on the number of therapy visits. Your doctor must order the therapy, and it must be medically necessary.

Home health care is another option if you are homebound or mostly homebound. Medicare Part A covers skilled nursing visits and therapy at home if a doctor orders them and you meet homebound criteria. Home health is often less expensive than facility care and allows you to recover in your own environment. However, home health requires someone to be present to help with daily tasks, so this option works best if you have family support or can hire a home aide.

Talk with your rehabilitation team before day 100 arrives about whether outpatient or home-based therapy makes sense for your recovery. Some people need the structure and intensity of facility care and are not ready to transition; others progress well enough that outpatient care is appropriate. Your physical therapist, occupational therapist, or physician can advise you on what is realistic for your situation.

Planning ahead with your care team

The facility's social worker or discharge planner should contact you and your family at least two weeks before your Medicare coverage ends. Ask them to provide a written summary of your coverage end date, your daily cost after that date, and the options they recommend for your next step. Do not wait for them to bring this up — ask directly: "When does my Medicare coverage end, and what are my options?"

Bring your family or a trusted person into these conversations. Decisions about continuing facility care, moving to assisted living, returning home, or exploring Medicaid are major ones, and you should not make them alone. If cost is a concern, tell the social worker — they may know about payment plans, charitable programs, or other resources specific to your facility or community.

If you have supplemental insurance (Medigap) or a Medicare Advantage plan, review your policy to see whether it covers any costs after day 100. Some Medigap plans cover part or all of the coinsurance for days 21–100, but very few cover costs after day 100. Your insurance company or agent can tell you what your policy includes.

Other payment sources and resources

Veterans may be covered by the Department of Veterans Affairs if they served on active duty. Some employers offer long-term care insurance that covers facility stays. If you have a life insurance policy with a long-term care rider, it may pay for continued care. Ask the facility's financial counselor whether any of these explore to you.

Some facilities participate in charity care programs or have sliding-scale fees based on income. Religious organizations, community foundations, and local nonprofits sometimes help pay for care. The social worker can point you toward these resources, but you may also search your city or county's 211 database (dial 2-1-1 or visit 211.org) to find local information programs.

If you are struggling to pay and the facility threatens discharge, ask to speak with the facility administrator or patient advocate. Facilities have rules about discharge procedures, and you have rights. A social worker or legal aid organization in your area can explain what those rights are.

Frequently Asked Questions

Can I stay in the facility after day 100 if I pay out of pocket?

Yes, if the facility agrees to keep you and you can pay the daily rate. However, facilities are not required to accept private-pay patients, and some discharge residents when Medicare coverage ends. Discuss this with the facility's business office before day 100 arrives so you know whether staying is an option.

Does my Medigap insurance cover costs after day 100?

Most Medigap plans cover some or all of the coinsurance for days 21–100, but almost none cover costs after day 100. Check your policy or call your insurance company to confirm what you have. If your plan does not cover post-100 costs, you will owe the full daily rate yourself.

What if I cannot afford to stay in the facility after Medicare ends?

Talk with the social worker about Medicaid, payment plans, charity care, or transitioning to a less intensive setting like assisted living or home care. If you are at risk of discharge, ask about your rights and whether legal aid or a patient advocate in your area can help you understand your options.

If I go home and then need to return to a facility, do I get another 100 days?

Only if you have been out of the facility for more than 60 days. If you return within 60 days, you continue using days from your current benefit period. If you are out for more than 60 days, a new benefit period starts and you get another 100 days of coverage.

Can I appeal if Medicare denies coverage before day 100?

Yes. If Medicare says you no longer need skilled care and stops paying before day 100, you can request an appeal. Ask the facility's social worker or billing department to help you file. You have the right to continue receiving care while your appeal is being reviewed, though you may owe the cost if the appeal is denied.