Do Medicare Benefits Cover Nursing Home Stays?

Hospital stays are often unexpected and almost always stressful. Whatever incident precipitated the hospitalization causes intense emotions that few people are prepared for and they are even less prepared to make the decisions they’ll be faced with next when it includes discharging to a Skilled Nursing Facility (“SNF”). Discharging from a hospital is often a “hurry up and wait" process fraught with the balancing act among choosing the best care, finding “an open bed”, and deciding how to pay for it. Understanding Medicare’s rules for SNF care is essential because confusion about SNF coverage can lead to unexpected bills.

What Is Skilled Nursing Facility Care?
SNF care is short-term, medically necessary care provided in a licensed facility following a hospital stay. SNFs offer a higher level of care than community based residential facilities or assisted living communities. Care must be provided by, or under the supervision of, licensed medical professionals such as registered nurses (RNs).
Why might someone need SNF care?

• Recovery after surgery
• Rehabilitation following a stroke or serious illness
• Wound care or IV therapy
• Physical, occupational, or speech therapy
• Monitoring and treatment of complex medical conditions

SNF care helps individuals recover and regain functioning with the goal of safely returning home or transitioning to a lower level of care.

When Does Medicare Cover SNF Care?
Medicare Part A (hospital insurance) covers SNF care only if specific conditions are met. To qualify for Medicare-covered SNF care, generally the following requirements must be met:

• A qualifying inpatient hospital stay. The person must have been admitted to a hospital as an inpatient for at least three consecutive days, not counting the day of discharge. Time spent in the hospital under “observation status” does not count toward this requirement.
• Admission to the SNF shortly after hospital discharge. The SNF stay usually must begin within 30 days of leaving the hospital.
• A medical need for skilled care. The care must be medically necessary and require skilled services, such as daily nursing care or rehabilitation therapy that can only be provided by trained professionals.
• A Medicare-certified skilled nursing facility. The facility must be certified by Medicare.

If these criteria are met, Medicare Part A may help pay for SNF care on a limited, short-term basis.

What Services Does Medicare Cover in a SNF?
When Medicare covers SNF care, it generally includes:

• A semi-private room
• Meals
• Skilled nursing services
• Physical, occupational, and speech therapy
• Medical supplies and equipment used during care
• Qualifying medications related to the SNF stay
• Ambulance transportation to the nearest provider of necessary services if other modes of transportation would pose a health risk

When Does Medicare Not Cover SNF Care?
In some situations, Medicare will not cover SNF care.
Medicare does not cover:

• Long-term or custodial care, such as help with bathing, dressing, or eating when no skilled medical care is required
• SNF stays that do not follow a qualifying three-day inpatient hospital admission
• Care in facilities that are not Medicare-certified
• Continued SNF care once the patient no longer needs skilled services

How Much Does SNF Care Cost Under Medicare?
Medicare-covered SNF care is limited to up to 100 days per benefit period (as defined by Medicare), and costs depend on how long a person is approved to stay.

• Days 1 to 20:  You pay $0 each day after paying the $1,736 Part A deductible amount in 2026.
• Days 21 to 100:  Part A covers part of the cost. You pay a coinsurance of $217 per day in 2026.
• After day 100:  You pay all the costs of SNF care.

Medigap (Medicare Supplement) plans may cover some or all the daily coinsurance for days 21 to 100, depending on the plan.

Why Understanding SNF Coverage Matters
Misunderstanding about SNF coverage can lead to financial strain and difficult decisions during an already stressful time. Many people assume Medicare will cover a stay in a skilled nursing facility indefinitely, when in reality, coverage is limited and tied strictly to skilled medical needs.
Before a hospital discharge, patients and caregivers should ask:

• Was the hospital stay at least three consecutive days and classified as inpatient rather than observation?
• Does the recommended SNF provide Medicare-certified SNF care?
• What services will be considered “skilled” and for how long?
• What happens when Medicare coverage ends?

What Happens When Medicare Stops Paying?
Often patients and their families are caught off guard when SNF staff approach them and share that Medicare coverage is ending. Unfortunately, this often happens well before the 100 days that was expected to be covered. Payment for care will need to transition to either private payment (this could be use of long-term care insurance benefits or personal cash reserves and retirement funds) or Medicaid (means tested government benefits that pay for long-term care). Finding oneself needing to privately pay for care, or unexpectedly apply for Medicaid, adds substantial stress to an already overwhelming situation.
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Is There A Way To Plan Ahead In Case I Am In This Situation?
Beyond knowing what Medicare will cover, proactive planning to protect your assets now and decide how to fund your long-term care later will help to decrease the strife when the unexpected happens. If you are interested in assessing options customized to your situation, contact our office to schedule a time to talk to one of our elder law attorneys about protecting your life savings should nursing home care be needed in the future. We are here to help you and your family be prepared.