Does Medicare Cover Skilled Nursing Facility (SNF) Care?

• Yes — Medicare Part A can cover short-term skilled nursing facility care when Medicare’s requirements are met.
  • This is generally rehabilitation or skilled medical care after a hospital stay.
  • It is not the same thing as long-term custodial nursing home care.
• Recovering after a hospital stay?
  • A Skilled Nursing Facility (SNF) may be appropriate.
• Need skilled care at home?
  • See our  Medicare Home Health Care page.
• Need ongoing help with bathing, dressing, eating or supervision?
  • See our  Long-Term Care information.
• Trying to choose a facility?
  • See our  How to Find & Compare Medicare Nursing Homes and Rehab Facilities.

The biggest Medicare questions are usually:

• Did you have the required inpatient hospital stay?
• Do you still need skilled care?
• How many Medicare-covered days are left?
• And what happens when Medicare coverage ends?
  • Scroll down for the answers…

When Does Medicare Cover a Skilled Nursing Facility?

• You must have Medicare Part A.
  • You must also have SNF days remaining in your Medicare benefit period.
• You generally need a qualifying hospital stay.
  • For Original Medicare, this normally means at least 3 consecutive inpatient hospital days.
  • The day you are admitted as an inpatient counts.
  • The day you leave the hospital does not count.
• You generally must enter the Skilled Nursing Facility within 30 days after leaving the hospital.
• You must need daily skilled nursing or skilled therapy.
  • Examples may include physical therapy, IV medication, wound care or other services requiring skilled personnel.
• The care must be provided in a Medicare-certified Skilled Nursing Facility.
• The skilled care must generally relate to:
  • A condition treated during your qualifying hospital stay; or
  • A new condition that develops while you are receiving covered SNF care for that condition.

Were You Actually Admitted as an Inpatient?

• Observation status does NOT count toward the 3-day inpatient requirement.
  • This is true even if you stay overnight in the hospital.
• Time in the emergency room before inpatient admission does not count.
• Ask the hospital what your official admission status is.
  • Do not assume that sleeping in a hospital bed means you were admitted as an inpatient.

What About Medicare Advantage?

• Medicare Advantage can work differently.
  • Some Medicare Advantage plans may waive the 3-day inpatient requirement.
  • Network, authorization and cost-sharing rules may also apply.
  • Check with your plan before entering a Skilled Nursing Facility whenever possible.
• See our  Medicare Advantage information.
• Official source:
• Medicare.gov — Skilled Nursing Facility Care
  

What Does Medicare Pay for Skilled Nursing in 2026?

• Days 1–20:
  • $0 per day for covered Skilled Nursing Facility services after the applicable Medicare Part A deductible.
• Days 21–100:
  • $217 per day in 2026.
• Day 101 and beyond:
  • Medicare pays $0 toward the SNF stay.
  • You generally pay the full cost unless another source of coverage applies.
• 2026 Medicare Part A deductible:
  • $1,736 per benefit period.
  • If you already paid the Part A deductible for hospital care during the same benefit period, you do not pay another Part A deductible simply because you transfer to a Skilled Nursing Facility.

Can Other Coverage Help?

• Medicare Supplement / Medigap
  • Depending on the policy, Medigap may pay some or all of the Medicare SNF coinsurance.
  • See our
    
    Medigap information.
• Medicare Advantage
  • SNF copays and other requirements vary by plan.
  • See our  Medicare Advantage information.
• Medi-Cal
  • Medi-Cal may help eligible California beneficiaries with longer-term nursing home costs.
  • See our How to Qualify for Medi-Cal Nursing Home Benefits.
• Long-Term Care Insurance
  • Benefits depend on the policy and whether the insured meets its eligibility requirements.
• Already approaching 100 days?
  • See our  What Happens After 100 Days of Skilled Nursing?
• Official source:
  • Medicare.gov — 2026 Medicare Costs
    

What Does Medicare Cover in a Skilled Nursing Facility?

• Semi-private room
• Meals
• Skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services
• Medications
• Medical supplies and equipment used in the facility
• Dietary counseling
• Certain medically necessary ambulance transportation
  • This may apply when other transportation would endanger your health and the needed service isn’t available at the SNF.
• See Official Medicare & Skilled Nursing Facility Care  Publication 11359   

What Doesn’t Medicare Pay for?

• Long-term or permanent nursing home residence just because someone can no longer live independently.
• Long-term custodial care when that is the only care needed.
  • Examples include ongoing help with bathing, dressing, eating or using the bathroom.
• SNF care after Medicare’s skilled-care requirements are no longer met.
• SNF care beyond Medicare’s benefit-period limit.
  • Another payer, such as Medi-Cal or long-term care insurance, may sometimes help.
• Need long-term help rather than short-term skilled medical care?
  • See our  Long-Term Care information.
• See Official Medicare & Skilled Nursing Facility Care  Publication 11359 

“They Say Mom Isn’t Improving — Does Medicare Have to Stop Paying?”

• Not necessarily.
  • Medicare skilled-care coverage does not depend only on whether the patient continues to improve.
• Skilled care may also be covered when it is medically necessary to:
  • Maintain the patient’s current condition;
  • Prevent deterioration; or
  • Slow further deterioration.
• A lack of improvement, by itself, is not enough to deny skilled care.
  • The important question is whether skilled nursing or skilled therapy continues to be medically necessary.
• This is sometimes called the Jimmo standard.
  • The Jimmo settlement clarified Medicare’s existing skilled-maintenance coverage rules.
    • The Jimmo Settlement Agreement from January 2013 clarifies that Medicare covers skilled nursing and therapy services to maintain a patient’s condition or slow a decline. Coverage cannot be denied simply because a patient lacks the potential to improve, applying to skilled nursing facilities, home health, and outpatient care  Google AI 
• Jimmo does NOT give someone unlimited nursing home coverage.
  • All of Medicare’s other eligibility requirements still apply.
  • The SNF benefit is still limited to as many as 100 covered days in a benefit period.
• Official source:
  • CMS — Jimmo Settlement
    

Medicare Says Your Skilled Nursing Coverage Is Ending — Can You Appeal?

• Yes — you may have the right to a fast appeal.
  • This can apply when you believe Medicare-covered SNF services are being ended too soon.
• Watch for a Notice of Medicare Non-Coverage.
  • In a Skilled Nursing Facility and certain other settings, you generally should receive this notice at least 2 days before covered services end.
• Read the notice immediately.
  • It explains why coverage is ending.
  • It tells you who to contact for a fast appeal.
  • It gives you the appeal deadline.
• The fast-appeal deadline can be extremely short.
  • Medicare says that in these settings you generally must follow the notice instructions no later than noon on the day before the termination date.
• An independent reviewer looks at the case.
  • The reviewer is called a Beneficiary and Family Centered Care-Quality Improvement Organization, or BFCC-QIO.
• If you have Medicare Advantage:
  • Different plan appeal rules may apply.
  • Follow the instructions on your notice and contact your plan promptly.
• Don’t put the notice aside and deal with it later.
  • Missing a fast-appeal deadline can affect your appeal rights and what you may have to pay.
• Official source:
  • Medicare.gov — Fast Appeals
    
  • Our webpage on Medicare Appeals

Does Medicare Give You 100 Nursing Home Days Every Year?

• No — Medicare does not automatically give everyone 100 nursing home days.
• Medicare Part A provides up to 100 covered SNF days in a benefit period.
  • You must continue meeting Medicare’s skilled-care requirements.
  • Coverage can end before day 100 if you no longer qualify for covered skilled care.
• A benefit period is not the same thing as a calendar year.
  • A benefit period begins when you are admitted as an inpatient to a hospital or Skilled Nursing Facility.
• A benefit period ends after 60 consecutive days without:
  • Inpatient hospital care; or
  • Skilled care in a Skilled Nursing Facility.
• A new benefit period can begin after the previous one ends.
  • If you again meet Medicare’s SNF requirements, another SNF benefit may become available.
• There is no limit on the number of benefit periods you can have.
  • But you must meet the Medicare requirements each time.
• Approaching or already past day 100?
  • See our  Over 100 Days of Skilled Nursing   page.

What Type of Care Do You Actually Need?

• Recovering after a hospital stay and need short-term rehabilitation or skilled nursing?
  • You may need a Skilled Nursing Facility (SNF).
• Need skilled nursing or therapy that can safely be provided at home?
  • See our  Medicare Home Health Care page.
• Need more medically intensive care than an ordinary Skilled Nursing Facility?
  • See our  Skilled Nursing vs. Sub-Acute Care.
• Need ongoing help with bathing, dressing, eating, toileting or supervision?
  • This may be a long-term or custodial care issue rather than short-term Medicare skilled care.
  • See our  Long-Term Care information.
• Could Medi-Cal help pay for a long-term nursing home?
  • See our  How to Qualify for Medi-Cal Nursing Home Benefits in California.
• Terminal illness and comfort-focused care?
  • See our  Medicare Hospice Coverage.

Find & Compare Skilled Nursing Facilities

• Start with our Nursing Home & Rehab Facility page.
  • How to Find & Pick a Medicare Nursing Home or Skilled Nursing Facility
• Medicare Care Compare
  • Find Medicare-certified nursing homes and compare quality information, staffing, inspections and other information.
  • Medicare.gov — Care Compare
    
• California Cal Health Find
  • Look up licensed and certified California health care facilities.
  • California Department of Public Health — Cal Health Find
    

Official Medicare Skilled Nursing Guides

• Quick Medicare SNF Guide
  • A short 4-page explanation of SNF eligibility, benefits, costs and appeal rights.
  • Getting Started: Medicare & Skilled Nursing Facility Care — Publication 11359
    
• Detailed Medicare SNF Guide
  • More detailed information on eligibility, costs, coverage ending, rights, appeals and choosing a facility.
  • Medicare Coverage of Skilled Nursing Facility Care — Publication 10153
    

Current Issues & Further Reading

• KFF Health News — Nursing Homes, Medicare & Prior Authorization
  • This is background and current news, rather than an official Medicare coverage rule.
  • These 3 Policy Moves Are Likely to Change Health Care for Older People
    

Questions About Medicare, Medigap or Medicare Advantage Coverage?

• Steve Shorr Insurance does not operate nursing homes or make medical placement decisions.
• We may be able to help you understand how your insurance coverage fits together, including:
  • Original Medicare;
  • Medicare Supplement / Medigap;
  • Medicare Advantage;
  • Medi-Cal;
  • Long-Term Care Insurance; and
  • Other insurance-related questions that come up when someone needs skilled nursing or long-term care.
• Questions about your particular situation?
  • Email Steve Shorr
  • Schedule a Zoom Meeting
• Disclaimer:
  • This page provides general educational information and is not medical, legal or tax advice.
  • Medicare benefits, costs, health plan networks, authorization requirements and government rules can change.
  • Always verify current benefits and eligibility with Medicare, your health plan, the facility and your health care providers.