Medicare Skilled Nursing

Does Medicare Cover Skilled Nursing Facility (SNF) Care?

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:

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?

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 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:
  • 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:

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:

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?

What Type of Care Do You Actually Need?

Find & Compare Skilled Nursing Facilities

Official Medicare Skilled Nursing Guides

Current Issues & Further Reading

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:
  • Questions about your particular situation?
  • 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.

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