Medicare Coverage of Skilled Nursing Facility Care: What You Need to Know

Who Should Read This

This publication is helpful for anyone who is enrolled in Medicare or will soon be eligible. It is especially important for people who have recently had a hospital stay and may need short-term skilled nursing or therapy services. Adults aged 60 and older who are planning ahead for recovery care should read this. Family members, caregivers, and loved ones helping someone navigate a hospital discharge or rehabilitation stay will also find this information valuable.

Quick Overview

This Medicare publication explains how Medicare helps cover care in a skilled nursing facility (SNF). It outlines who qualifies for this benefit, what services are covered, how long coverage lasts, and what costs may apply. The publication also explains your rights as a Medicare beneficiary in a skilled nursing facility setting.

Key Takeaways

• Medicare Part A may cover skilled nursing facility care, but only under certain conditions.
• You must have a qualifying hospital stay of at least 3 days as an inpatient before Medicare will cover SNF care.
• Coverage is available for up to 100 days per benefit period, but the level of coverage changes after the first 20 days.
• Medicare covers skilled care such as physical therapy, occupational therapy, speech-language therapy, and skilled nursing services — not just custodial care.
• You have important rights in a skilled nursing facility, including the right to appeal discharge decisions.
• Medicare does not cover long-term or custodial care in a nursing home if that is the only type of care you need.
• You should review your Medicare Summary Notice and Explanation of Benefits to stay informed about your SNF coverage and any costs you may owe.

Publication Summary

What Is a Skilled Nursing Facility?

A skilled nursing facility, often called an SNF, is a special type of facility that provides medical and rehabilitative care. This is different from a regular nursing home or long-term care facility. Medicare only covers care in an SNF when you need skilled nursing or therapy services on a daily basis — services that cannot be provided safely at home or in a lower-level care setting.

Who Qualifies for Medicare SNF Coverage?

To qualify for Medicare-covered SNF care, you must meet all of the following conditions. First, you must be enrolled in Medicare Part A and have days available in your benefit period. Second, you must have had a qualifying inpatient hospital stay of at least 3 consecutive days, not counting the day of discharge. Third, your doctor must certify that you need daily skilled care such as skilled nursing services or physical, occupational, or speech therapy. Fourth, you must be admitted to a Medicare-certified skilled nursing facility. Finally, your care must be for a condition that was treated during your qualifying hospital stay or for a condition that arose while you were receiving SNF care for a hospital-related condition.

What Does Medicare Cover in a Skilled Nursing Facility?

Medicare Part A covers a range of services in a qualifying SNF stay. Covered services include a semi-private room, meals, skilled nursing care, physical and occupational therapy, speech-language pathology services, medical social services, medications as part of your SNF care, and medical supplies and equipment used during your stay. It is important to understand that Medicare does not cover personal care or custodial services — such as help with bathing or dressing — if those are the only services you need.

How Long Does Coverage Last?

Medicare SNF coverage is organized by benefit periods. A benefit period begins the day you are admitted as an inpatient in a hospital or SNF and ends when you have not received inpatient hospital or SNF care for 60 days in a row. During each benefit period, Medicare Part A may cover up to 100 days of SNF care. For the first 20 days, Medicare pays the full approved cost. From day 21 through day 100, you are responsible for a daily coinsurance amount. After day 100, Medicare no longer covers SNF care for that benefit period. There is no limit on the number of benefit periods you can have during your lifetime.

The 3-Day Inpatient Hospital Stay Rule

This rule is one of the most important — and commonly misunderstood — requirements for SNF coverage. You must be formally admitted as an inpatient for at least 3 consecutive days. Time spent in the hospital under observation status does not count toward this 3-day requirement, even if you stayed overnight. If you are unsure of your status, ask your hospital care team whether you are admitted as an inpatient or under observation.

Your Rights in a Skilled Nursing Facility

Medicare beneficiaries in skilled nursing facilities have important rights. You have the right to be treated with dignity and respect. You have the right to be informed about your care and to participate in decisions about your treatment. You also have the right to a written notice before your Medicare-covered care ends, along with information about how to appeal that decision. The notice is called a Notice of Medicare Non-Coverage. If you receive this notice, you can request a fast appeal review through your Beneficiary and Family Centered Care Quality Improvement Organization, sometimes called a BFCC-QIO. Filing an appeal in time means Medicare will continue to cover your care while the appeal is being reviewed.

What Is Not Covered

Medicare does not cover long-term custodial care, personal care only, or a private room unless it is medically necessary. It also does not cover most dental care, eye care, or hearing aids provided during an SNF stay. If you need help understanding what will and will not be covered, talk to the SNF's billing office or contact Medicare directly.

Frequently Asked Questions

Does Medicare cover a nursing home stay permanently?

No. Medicare only covers skilled nursing facility care for short-term recovery and rehabilitation. Coverage lasts up to 100 days per benefit period and only when skilled care is medically necessary. Medicare does not pay for long-term or custodial nursing home stays.

What if I was in the hospital under observation status — does that count toward the 3-day rule?

No. Only time spent as a formally admitted inpatient counts. Observation status time, even if you stayed overnight, does not count toward the 3-consecutive-day inpatient requirement needed to qualify for Medicare SNF coverage.

What happens after 20 days in a skilled nursing facility?

After the first 20 days, you become responsible for a daily coinsurance amount through day 100. After day 100, Medicare no longer covers your SNF stay for that benefit period. You may want to look into supplemental insurance, such as a Medigap plan or Medicare Advantage plan, to help cover those costs.

Can I appeal if my Medicare SNF coverage is ending?

Yes. You have the right to appeal if you believe your Medicare-covered SNF care is ending too soon. You must receive a written Notice of Medicare Non-Coverage before coverage ends, and you can request a fast appeal. If you file in time, your care continues to be covered during the review process.

Does Medicare Advantage cover skilled nursing facility care?

Medicare Advantage plans, which are offered by private insurance companies approved by Medicare, are required to cover at least the same benefits as Original Medicare, including SNF care. However, the rules, costs, and network requirements may differ from plan to plan. Check with your Medicare Advantage plan for specific details about your SNF benefits.

Access the Full Publication

Publication Number: 10153
Publication Date: August 2025
Length: 36 pages