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Understanding Medicare Skilled Nursing Facility Coverage

Medicare Part A covers stays at skilled nursing facilities (SNFs) when specific conditions are met. A skilled nursing facility is a specialized facility that provides medical care beyond what can be delivered at home. These facilities employ nurses, therapists, and other medical professionals who work around the clock. Understanding what Medicare covers at these facilities helps people and their families make informed decisions about care options.

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Medicare covers SNF care only after a hospital stay. The person must have been admitted to the hospital as an inpatient for at least three consecutive calendar days. This three-day requirement is strict—time spent in the emergency room or as an outpatient does not count toward this requirement. After discharge from the hospital, the person must enter the SNF within 30 days to have Medicare coverage connected to that hospital stay.

The care received at the SNF must relate to the condition treated during the hospital stay. For example, if someone was hospitalized for pneumonia and then moves to an SNF for breathing therapy and medication management related to that pneumonia, Medicare would likely cover the stay. However, if the person goes to an SNF for an unrelated condition, the three-day hospital requirement would not apply.

Medicare Part A also requires that the care be "skilled care." Skilled care involves services that only trained medical professionals can provide. Physical therapy to regain mobility after a stroke, wound care that requires a nurse, or medication management for complex conditions all count as skilled care. Basic assistance with daily activities like bathing or dressing, without a medical component, does not count as skilled care for Medicare coverage purposes.

Practical takeaway: Before entering an SNF, verify with the facility that Medicare Part A will cover the stay based on the three-day hospital requirement and the skilled care needs. Keep discharge paperwork from the hospital, as it documents the inpatient admission and the medical reason for SNF care.

How the 100-Day Coverage Limit Works

Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period. This is not 100 days per year—it is 100 days per benefit period. A benefit period begins when a person enters the hospital and ends after they have not received hospital or SNF care for 60 consecutive days. Once 60 days pass without hospital or SNF services, a new benefit period starts, and the person gets another 100 days of coverage.

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The 100 days are not split evenly between the hospital and SNF. Instead, each day counts as one day used from the 100-day pool, regardless of whether it is a hospital day or an SNF day. For example, if someone spends 5 days in the hospital and then 45 days in an SNF, 50 days from the 100-day limit have been used. They would have 50 days remaining in that benefit period.

Days in the SNF are counted differently depending on the cost-sharing structure. For the first 20 days, Medicare covers the full cost of the SNF stay, and the person pays nothing. From day 21 through day 100, the person pays a daily coinsurance amount. In 2024, this daily coinsurance was $194.50 per day. This means the person shares the cost with Medicare during days 21-100, while Medicare covers the remainder.

If a person uses all 100 days in a benefit period, they must pay the full cost of any SNF care after day 100. This can be expensive, as SNF care typically costs between $200 and $400 per day, depending on the facility and location. Some people have supplemental insurance (Medigap) or Medicaid that may help pay for days after the 100-day limit, but this varies by individual circumstances.

Practical takeaway: Track how many SNF days have been used in the current benefit period. Ask the SNF to provide a written statement of the number of covered days remaining. Understanding this number helps plan for potential costs if the stay extends beyond the covered period.

Coinsurance Costs During Days 21-100

Starting on day 21 of an SNF stay, Medicare beneficiaries must pay a daily coinsurance amount. This is a set dollar amount per day that represents the person's share of the SNF cost. Medicare pays the remainder. The coinsurance amount changes each year based on Medicare's cost calculations. In 2024, the daily coinsurance was $194.50, and in 2025, it is $195. These amounts are subject to change annually.

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The coinsurance applies to all SNF services covered by Medicare, including room and board, nursing care, medications, therapy, and other medically necessary services. The person cannot reduce this cost by choosing a less expensive SNF—the coinsurance amount is the same across all facilities. Some facilities may charge additional amounts for items not covered by Medicare, such as television rental or phone service, but these are separate from the coinsurance.

Many people choose to cover the coinsurance with supplemental insurance, also called Medigap. Certain Medigap plans pay for part or all of the SNF coinsurance. Plans C, D, F, G, M, and N all include some level of SNF coinsurance coverage. However, the exact coverage varies by plan, and enrollment in Medigap happens during specific times, typically when a person first becomes eligible for Medicare at age 65.

Medicaid, a federal-state program for people with low income, may also cover SNF coinsurance for those who qualify. Some nursing home residents use Medicaid to pay for days beyond the 100-day limit. The rules for Medicaid coverage of SNF care differ by state, so it is important to check with your state's Medicaid program for specific information.

Practical takeaway: When admitted to an SNF, ask for an estimate of the total coinsurance costs based on the expected length of stay. Factor this into financial planning, and review whether current insurance coverage (Medigap, Medicaid, or other) will help with these costs.

What Medicare Does and Does Not Cover in SNFs

Medicare covers a broad range of services at SNFs when they are medically necessary and part of a skilled care plan. Skilled nursing care is the primary covered service and includes medication management, wound care, catheter care, and monitoring of vital signs. Physical therapy, occupational therapy, and speech-language pathology services are covered when ordered by a doctor and provided by a licensed professional. Respiratory therapy, medical supplies like bandages and catheters, and laboratory tests ordered as part of treatment are also covered.

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Room and board at the facility—including the bed, meals, and basic utilities—are covered as part of the SNF stay. Medications prescribed during the stay are covered. Television, phone, and other amenities that enhance comfort but are not medically necessary are not covered. Doctors' visits may be covered, though some doctors charge fees beyond what Medicare pays.

Medicare does not cover custodial care, which is assistance with daily living activities that do not have a medical component. Help with bathing, dressing, toileting, and eating is considered custodial care and is not covered by Medicare alone. This is an important distinction because many SNF stays involve both skilled and custodial care. Medicare covers the skilled portion, but the person may pay privately for the custodial portion, or Medicaid may cover it for those who qualify.

SNF care that continues after the 100-day limit is not covered by Medicare Part A. Some SNFs offer continuing care on a private-pay basis, meaning the person or their family pays the full cost. Others may transition the person to Medicaid coverage if they qualify. Respite care—short-term care to give family caregivers a break—is not covered by Medicare in SNFs, though it may be covered in other settings like hospice.

Practical takeaway: Before admission, ask the SNF to provide a clear list of what will and will not be covered by Medicare. Understand that after the 100-day limit, the person will need to arrange alternate payment methods or potentially move to a Medicaid-certified facility if they qualify for that program.

The Three-Day Hospital Stay Requirement Explained

The three-day hospital stay requirement is one of the most important rules for SNF coverage under Medicare Part A. The requirement states that a person must be admitted to the hospital as an inpatient for at least three consecutive

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