Medicare covers skilled nursing facility care, but only under specific conditions

Medicare Part A will pay for a skilled nursing facility (SNF) stay, but the facility must be Medicare-certified, you must have spent at least three consecutive days in a hospital first, and you must be admitted to the SNF within 30 days of leaving the hospital. The stay must be for a condition related to your hospital stay, and a doctor must order it as medically necessary. If any of these conditions is not met, Medicare will not pay.

The difference between a skilled nursing facility and other types of care matters. A skilled nursing facility provides medical care under a doctor's supervision — wound care, physical therapy, medication management, or monitoring after surgery. A regular nursing home or assisted living facility provides custodial care — help with bathing, dressing, meals — and Medicare does not pay for that, even if the facility has "nursing" in its name.

Understanding what Medicare will and will not cover can save you thousands of dollars and help you plan ahead if you know a hospital stay is coming.

Key Takeaways

  • Medicare Part A covers up to 100 days in a Medicare-certified skilled nursing facility if you meet the hospital stay requirement and admission timing.
  • You must have been admitted to a hospital for at least three consecutive days before Medicare will pay for SNF care — observation stays do not count.
  • The SNF stay must begin within 30 days of your hospital discharge, and the condition being treated must relate to your hospital diagnosis.
  • You pay nothing for days 1–20, a daily copay (currently $200 per day) for days 21–100, and all costs after day 100.
  • If you do not meet these conditions, you will owe the full cost of the facility unless you have a supplemental insurance policy that covers it.

The three-day hospital stay requirement

Medicare requires a three-day inpatient hospital stay before it will pay for a skilled nursing facility. This means you must be formally admitted to the hospital as an inpatient — not treated in the emergency room, not kept for observation, but admitted with an inpatient status. The three days do not have to be consecutive calendar days; they count as three separate days you spent in the hospital, even if one was a partial day.

Many people are kept in the hospital under "observation status" instead of being admitted as inpatients. Observation stays do not count toward the three-day requirement, even if you spend three calendar days in the hospital. This is a common source of confusion and expense. If you are unsure whether you were admitted as an inpatient or kept under observation, ask the hospital billing department or check your discharge paperwork — it will say "inpatient" or "observation" clearly.

If you were observed but not admitted, and you later need skilled nursing care, Medicare will not pay. You can appeal the observation status decision, but this must be done quickly — usually within 24 hours of receiving notice. Contact the hospital's patient advocate or call 1-800-MEDICARE to ask about the appeal process.

The 30-day window and related-condition rule

You must be admitted to the skilled nursing facility within 30 days of leaving the hospital. If you go home first and then enter a SNF two months later, Medicare will not pay, even if you were hospitalized for a serious condition. The clock starts on your hospital discharge date.

The condition you are being treated for in the SNF must be related to the condition that sent you to the hospital. For example, if you were hospitalized for pneumonia and then admitted to a SNF for pneumonia recovery and physical therapy, Medicare will pay. If you were hospitalized for pneumonia but then admitted to a SNF for a knee replacement you had planned before the hospital stay, Medicare will not pay for the knee replacement care — though it may pay for pneumonia-related care if that is still medically necessary.

Medicare reviews the medical record to confirm the connection. The doctor ordering the SNF admission and the SNF itself will document this, so you do not need to prove it yourself, but it is worth understanding in case there is a question later.

How many days Medicare pays for

Medicare Part A covers up to 100 days in a Medicare-certified skilled nursing facility per 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 readmitted to the hospital after that 60-day window, a new benefit period begins.

You pay nothing for the first 20 days. For days 21 through 100, you pay a daily copay. This copay amount changes each year — it is currently $200 per day, but confirm the current amount with your SNF or Medicare before admission. After day 100, you owe the full cost of the facility.

If you leave the SNF and return to the hospital, and then are readmitted to a SNF within the same benefit period, the days you already used count against your 100-day limit. For example, if you spent 30 days in a SNF, went home for two weeks, then returned to the hospital and were readmitted to a SNF, you would have 70 days of coverage left in that benefit period.

What "Medicare-certified" means and how to verify it

Not every nursing facility is Medicare-certified. A facility must meet federal standards for staffing, medical equipment, infection control, and documentation to accept Medicare payment. If a facility is not certified, Medicare will not pay, regardless of whether you meet all other requirements.

You can check whether a facility is Medicare-certified by visiting Medicare.gov and using the Care Compare tool, or by calling 1-800-MEDICARE. The SNF itself should tell you whether it is certified when you ask. If you are being discharged from a hospital, the hospital discharge planner will typically recommend only certified facilities, but it is worth confirming, especially if you are considering a facility on your own.

Some facilities are certified for Medicare but have limited beds available for Medicare patients, or they may not accept certain types of cases. Call ahead and confirm that the facility will accept your case and that it has an available bed before you count on it.

What happens if you do not meet the requirements

If you do not meet the three-day hospital stay requirement, the 30-day window, the related-condition rule, or the facility is not Medicare-certified, Medicare Part A will not pay. You will owe the full daily cost of the facility.

Some people have supplemental insurance (also called Medigap) that covers some or all of the SNF costs Medicare does not pay. Check your policy to see what it covers. If you do not have supplemental insurance and cannot pay out of pocket, ask the SNF about payment plans or whether it has financial information programs. Some facilities offer reduced rates for uninsured or underinsured patients, though this is not may provide.

Medicaid may cover SNF care if you meet income and asset limits, but Medicaid rules vary by state. Contact your state Medicaid office or call 211 to ask whether you might be covered.

Planning ahead if you know a hospital stay is coming

If you are scheduled for surgery or know you will need hospitalization, ask your doctor whether you will need skilled nursing care afterward. If the answer is yes, confirm that you will be admitted as an inpatient (not observation), and ask the hospital to arrange the SNF admission before you are discharged. This prevents gaps and ensures the SNF is ready for you on the day you leave the hospital.

If you are concerned about costs, review your Medicare coverage and any supplemental insurance you have. Know what your copay will be for days 21–100. If you think you might need more than 100 days of care, ask your doctor and the SNF social worker about other options, such as home health care or outpatient therapy, which may be covered differently.

Keep copies of your hospital discharge paperwork and your SNF admission paperwork. These documents show the dates and the medical reason for admission, which you may need if there is ever a question about coverage.

Frequently Asked Questions

Does an observation stay count toward the three-day requirement?

No. Only inpatient hospital stays count. If you were kept under observation status, those days do not count, even if you spent three calendar days in the hospital. You can appeal the observation status decision, but you must do so within 24 hours of receiving notice. Call 1-800-MEDICARE for help with the appeal.

What if I go home after the hospital and then need a SNF two months later?

Medicare will not pay. The SNF admission must occur within 30 days of hospital discharge. If you need care later, you would have to pay out of pocket or use Medicaid if you may have access to. Plan SNF care before you leave the hospital if you think you will need it.

Can Medicare pay for a SNF stay if I was never hospitalized?

No. The three-day inpatient hospital stay is a requirement Medicare does not waive. If you need skilled nursing care without a recent hospital stay, you would need to pay out of pocket or use Medicaid if you may have access to in your state.

What if the SNF says it is not Medicare-certified?

Medicare will not pay. Ask the facility for a list of certified SNFs in your area, or use the Care Compare tool on Medicare.gov to find one. Your hospital discharge planner can also recommend certified facilities.

Do I have to use the SNF the hospital recommends?

No. You can choose any Medicare-certified SNF. However, the hospital discharge planner can help you find one with available beds and confirm it will accept your case. If you choose a facility on your own, call ahead to confirm it is certified and has space for you before you are discharged.