What Happens After 100 Days of Skilled Nursing Care?

Medicare Skilled Nursing Facility coverage does not automatically continue after 100 days.

• Original Medicare Part A provides up to 100 covered Skilled Nursing Facility (SNF) days in a benefit period.
  • You must continue meeting Medicare’s skilled-care requirements during those days.
    • premera.com Guidelines  
    • Cal. Code Regs. Tit. 22, § 51335 – Skilled Nursing Facility Services  
  • 100 days is a maximum — not a guarantee that everyone receives 100 covered days.
• Beginning with day 101, Original Medicare pays $0 for the SNF stay.
  • You are responsible for the cost unless another payer applies.
• Medigap does not create another 100 days of SNF coverage.
  • Medigap plans help pay the Medicare coinsurance during days 21–100.
    • Get Quotes, Summaries & Comparisons
  • They do not extend the Medicare SNF benefit beyond day 100.
• You may eventually qualify for a new 100-day benefit period.
  • But there must first be a qualifying break in the current benefit period.
  • In most situations, you must then satisfy Medicare’s SNF eligibility requirements again.
• See our  webpage on  Medicare Skilled Nursing Facility Coverage 
  • Medicare Coverage of Skilled Nursing Facility Care — Publication 10153

What Do You Do When Medicare’s 100 SNF Days Run Out?

• First, find out whether you still need skilled care or now need long-term custodial care.
  • These are not the same thing.
  • Medicare’s SNF benefit is designed primarily for short-term skilled nursing and rehabilitation.
  • Medicare generally does not pay for long-term custodial nursing home care when that is the only care needed.
• Ask the facility for its private-pay rate in writing.
  • Ask what the daily or monthly rate includes.
  • Ask whether therapy, medications, supplies or other services are billed separately.
  • There is no Medicare rule requiring the facility to continue charging you the Medicare reimbursement rate after your Part A SNF benefit is exhausted.
• Check whether another payer can help.
  • Medi-Cal nursing home benefits;
  • An existing Long-Term Care Insurance policy;
  • Medicare Advantage plan benefits;
  • Employer or retiree coverage;
  • Veterans benefits, when applicable; or
  • Other public or private assistance.
• Don’t assume Medicare stops paying for every medical service just because Part A SNF days are exhausted.
  • Medicare Part B may continue covering otherwise eligible services such as physician visits and certain physical, occupational or speech therapy services.
  • Part B does not turn the nursing home’s room and board into a covered Medicare benefit.

Does Medigap Pay for Skilled Nursing After Day 100?

• No — standard Medigap benefits do not extend Medicare’s SNF benefit beyond day 100.
• During days 21–100:
  • Original Medicare requires a daily SNF coinsurance.
  • Some Medigap plans pay all or part of that coinsurance.
• Beginning with SNF day 101:
  • Original Medicare pays $0 for the SNF stay.
  • The standardized Medigap SNF coinsurance benefit also ends.
  • You are responsible for the facility’s charges unless another payer applies.
• What about the famous “365 additional days” in Medigap?
  • Those are additional inpatient HOSPITAL days.
  • They are not 365 additional Skilled Nursing Facility days.
• The Anthem 2026 California brochure makes the distinction clear.
  • For SNF day 101 and after, the chart shows Medicare pays $0 and the Medigap plan pays $0 for the SNF benefit.
  • The separate footnote about 365 additional days applies to hospitalization.
• See our  Medicare Supplement / Medigap information webpage.

Can Medicare’s 100 Skilled Nursing Days Reset?

• Yes — the 100-day limit is per benefit period, not per lifetime and not necessarily per calendar year.
• A benefit period can end after 60 consecutive days without:
  • Inpatient hospital care; and
  • Skilled-level care in a Skilled Nursing Facility.
• After that benefit period ends, a new benefit period can begin.
  • If you again meet Medicare’s SNF requirements, you may qualify for up to another 100 SNF days.
  • A new Part A deductible may apply in the new benefit period.
• There is no lifetime limit on the number of benefit periods.
  • But you have to qualify each time.

The Important Part Most People Miss

• If you continue receiving skilled-level care after day 100, the 60-day clock does NOT start just because Medicare stopped paying.
  • You can exhaust Medicare’s 100 paid SNF days and still be receiving a skilled level of care.
  • As long as you continue to need and receive that skilled level of care in the SNF, the current benefit period continues.
• If skilled care stops and you receive only custodial/non-skilled care, the situation is different.
  • The 60-day break can begin even if you physically remain in a nursing facility.
  • For this technical benefit-period rule, CMS focuses on whether you still need and receive a skilled level of care.
• You could also spend the 60 days:
  • At home;
  • In assisted living; or
  • In another non-skilled/custodial setting.
• CMS Medicare Manual — Benefit Period Rules

Example: How Could Someone Qualify for Another 100 SNF Days?

• Step 1 — The person uses all 100 Medicare SNF days.
• Step 2 — Skilled-level SNF care eventually stops.
  • The person might go home, move to assisted living, or remain in a nursing facility receiving custodial care only.
• Step 3 — At least 60 consecutive days pass without inpatient hospital care or skilled-level SNF care.
  • The old benefit period can then end.
• Step 4 — Later, the person again needs skilled nursing care.
• Step 5 — In Original Medicare, the person generally must meet the SNF requirements again.
  • Have Medicare Part A;
  • Have a qualifying inpatient hospital stay — normally at least 3 consecutive inpatient days;
  • Need daily skilled nursing or therapy;
  • Generally enter the SNF within 30 days after leaving the hospital; and
  • Receive care in a Medicare-certified SNF.
• Step 6 — A new benefit period starts.
  • If all requirements are met, Medicare can again provide up to 100 SNF benefit days.

Does the New Illness Have to Be the Same as the Old Illness?

• No.
  • The benefit-period reset isn’t tied to having the exact same disease or injury.
  • The important issues are whether the prior benefit period ended and whether the person now meets Medicare’s coverage requirements.
• Medicare Advantage can have different rules.
  • Some Medicare Advantage plans waive the 3-day inpatient hospital requirement.
  • Check your plan’s network, authorization and coverage rules.

Who Can Help Pay After Medicare’s 100 Days?

• Medi-Cal Nursing Home Benefits
  • For eligible Californians, Medi-Cal may help pay for longer-term nursing facility care.
  • Medi-Cal eligibility is a separate issue from Medicare’s 100-day SNF rule.
  • Income, eligibility, transfers of assets and any applicable patient liability or Share of Cost need to be reviewed carefully.
  • See our  How to Qualify for Medi-Cal Nursing Home Benefits in California.
• Existing Long-Term Care Insurance
  • If a policy is already in force, review its benefit triggers, elimination period, daily or monthly benefit and covered settings.
  • See our  Long-Term Care Information.
• Home Health Care
  • If the person can safely return home and meets Medicare’s requirements, Medicare-covered home health services may be an option.
  • Home health is not 24-hour custodial caregiving.
  • See our  Medicare Home Health Care.
• PACE — Program of All-Inclusive Care for the Elderly
  • For some people who need a nursing-home level of care but can safely live in the community, PACE may be an alternative.
  • See our  California PACE Program Guide.
• Private Pay
  • If no other payer applies, the resident or family may have to pay the nursing facility directly.

What If Medi-Cal Starts Paying for the Nursing Home?

• That is different from being a private-pay resident after Medicare ends.
• Participating Medicaid/Medi-Cal providers generally must accept the Medicaid payment plus any permitted patient cost-sharing as payment in full for covered services.
  • They cannot simply collect the Medi-Cal payment and then bill the resident the difference between the Medi-Cal rate and their ordinary private-pay rate for the same covered service.
• The resident may still have an amount he or she is required to contribute.
  • The amount depends on the person’s Medi-Cal situation and applicable long-term-care rules.
• Do not confuse this with a Medicare “discount after day 100.”
  • The lower government payment obligation exists because Medi-Cal became the payer, not because Medicare requires a discounted day-101 nursing-home price.

See our  Medi-Cal Nursing Home Benefits Guide.

What If Medicare Stops Paying BEFORE You Reach 100 Days?

• That is a different issue from exhausting all 100 benefit days.
• Medicare does not guarantee 100 days.
  • You must continue needing covered skilled nursing or skilled therapy.
• But you do NOT have to keep getting better in order for skilled care to qualify.
  • Skilled care can be medically necessary to maintain your condition.
  • It can also be needed to prevent or slow deterioration.
• “You’ve plateaued” or “you’re not improving” is not, by itself, enough to deny otherwise-covered skilled care.
  • This principle is often called the Jimmo standard.
• If Medicare-covered services are being stopped too soon, appeal rights may apply.
  • Read any notice immediately.
  • Fast-appeal deadlines can be very short.
• Official source:  CMS — Jimmo Settlement FAQs.

Could a Long-Term Acute Care Hospital Be the Next Step?

• Possibly — but only when medically appropriate.
• A Long-Term Acute Care Hospital (LTACH) is a hospital, not simply a nursing home that lets you stay longer.
  • LTACH patients generally have serious medical conditions requiring hospital-level treatment for an extended period.
• Do not use LTACH admission as a strategy simply to get around Medicare’s 100-day SNF limit.
  • The patient must medically qualify for that level of care.
• Insurance rules are also different.
  • Hospital Part A rules apply differently from the SNF 100-day benefit.
  • Secondary insurance or Medicare Advantage coverage may also affect costs.
• See our  Skilled Nursing vs. Sub-Acute Care.

Could a Long-Term Acute Care Hospital Be the Next Step?

• Possibly — but only when medically appropriate.
• A Long-Term Acute Care Hospital (LTACH) is a hospital, not simply a nursing home that lets you stay longer.
  • LTACH patients generally have serious medical conditions requiring hospital-level treatment for an extended period.
• Do not use LTACH admission as a strategy simply to get around Medicare’s 100-day SNF limit.
  • The patient must medically qualify for that level of care.
• Insurance rules are also different.
  • Hospital Part A rules apply differently from the SNF 100-day benefit.
  • Secondary insurance or Medicare Advantage coverage may also affect costs.
• See our  Skilled Nursing vs. Sub-Acute Care.

Frequently Asked Questions

Does Medicare ever pay more than 100 SNF days in one benefit period?

• Generally, no.
  • Original Medicare Part A is limited to 100 SNF benefit days in each benefit period.

Does Medigap Plan G or Plan F give me more than 100 SNF days?

• No.
  • Medigap may cover applicable SNF coinsurance during days 21–100.
  • It does not add another block of SNF days after Medicare’s 100 days are exhausted.

What are the 365 additional Medigap days?

• They are inpatient hospital days — not Skilled Nursing Facility days.

Can I get another 100 SNF days after 60 days?

• Potentially, yes.
  • Your old benefit period must end.
  • You must then meet Medicare’s requirements for the new SNF stay.

Do I have to leave the nursing home for 60 days?

• Not necessarily.
  • The technical Medicare rule is based on whether you are receiving a skilled level of SNF care.
  • If you remain in the facility for custodial/non-skilled care only, the 60-day break may still run.

What if I still need skilled care after day 100?

• Medicare Part A still stops paying for the SNF stay after the 100 covered days are exhausted.
  • If you continue receiving skilled-level care, however, the current benefit period generally continues rather than resetting.

Does the nursing home have to give me the Medicare rate after day 100?

• No general Medicare rule requires that.
  • If you are private pay, ask the facility for its private-pay charges.
  • If Medi-Cal becomes the payer, different payment-in-full rules apply.

Related Guides & Official Resources

• Medicare Skilled Nursing Facility Coverage
  
• How to Qualify for Medi-Cal Nursing Home Benefits in California
  
• Medicare Home Health Care Coverage
  
• How to Find & Compare Medicare Nursing Homes and Rehab Facilities
  
• Medicare.gov — Skilled Nursing Facility Care
  
• Medicare Coverage of Skilled Nursing Facility Care  Publication 10153
  
• CMS Medicare General Information, Eligibility & Entitlement Manual
  

Questions About Your Medicare or Insurance Coverage?

• Steve Shorr Insurance may be able to help explain:
  • Original Medicare;
  • Medicare Supplement / Medigap;
  • Medicare Advantage;
  • Long-Term Care Insurance; and
  • How the different insurance pieces may fit together.
• For Medi-Cal eligibility or elder-law planning:
  • We can provide educational information and resources, but we are not an elder-law firm and do not prepare Medi-Cal applications.
• Contact Steve
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Disclaimer:
This page provides general educational information and is not medical, legal or tax advice.
Medicare, Medi-Cal and health plan rules can change, and individual circumstances matter.
Verify current coverage with Medicare, your health plan, the nursing facility and appropriate legal or benefits professionals before making financial or care decisions.