Medicare provides limited coverage for skilled nursing facility care. Medicare covers skilled nursing care facilities after hospital admission for up to 100 days for certain conditions.

Wondering whether Medicare will pay for skilled nursing care? Yes, it does, in some limited circumstances, but the coverage limits can be confusing. There are also very specific requirements you have to meet before your stay.

In a nutshell, Medicare will pay for short-term skilled nursing facility stays only for specific situations. If you need ongoing or long-term care in a skilled nursing facility, you’ll have to pay out of pocket or use other programs to fund these services.

The short answer is yes. Medicare is a federal healthcare program for people ages 65 years old and older and those with qualifying medical conditions. Medicare coverage is split into a few programs, which offer different types of coverage at various costs.

Medicare Part A

Medicare Part A provides inpatient hospital coverage. Part A and Part B together are sometimes called Original Medicare. You usually don’t have to pay a monthly premium for Medicare Part A if you paid into the Medicare system through taxes during a portion of your working years.

You can enroll in Medicare Part A when you turn 65 or if you have certain medical conditions. This is the portion of Medicare that will cover a skilled nursing facility stay, a rehabilitation center stay, hospice care, and certain home healthcare services.

For most people, Part A is free because their spouse worked at least 40 calendar quarters (10 years) and paid Medicare taxes during that time.

If you must pay a monthly premium for Part A, it ranges from $278 to $505 in 2024, depending on your work history.

Medicare Part B

For Medicare Part B, you’ll pay a monthly premium based on your income level. In 2024, most people will pay $174.70 per month. Part B covers most outpatient medical care.

Medicare Part C

Medicare Part C, or Medicare Advantage, plans are sold by private insurance companies. These plans combine all the elements of Original Medicare and sometimes extra coverage for prescription drugs, vision, dental, and more. There are many Medicare Advantage plans available, so you can choose one based on your needs and financial situation.

Medicare Part D and Medigap

Medicare Part D provides prescription drug coverage. Private supplemental plans, called Medigap plans, can offer extra coverage for services not paid for under the other Medicare programs.

Medicare Part A covers the cost of a skilled nursing facility for conditions that begin with a hospital stay and require ongoing care after discharge. While this seems simple, a few specific criteria apply:

  • Your illness or injury must require a hospital stay: Some examples of these events are a fall, a stroke, a heart attack, pneumonia, worsening heart failure, worsening chronic obstructive pulmonary disease (COPD), and surgery.
  • There is a required length of stay: The initial hospital stay must last at least 3 days.
  • While in the hospital, you must be considered an inpatient: Being in the hospital under observation is not considered a qualifying hospital stay. Time spent in the emergency department, time spent under observation, and the day of discharge cannot be counted toward Medicare’s 3-day rule.
  • When you’re discharged, your doctor must order ongoing care: This means you need 24-hour care at a skilled nursing facility for the condition for which you were hospitalized.
  • You’re covered for any conditions you develop while at a skilled nursing facility: An example of this could be getting an infection while receiving rehab services after joint replacement surgery.

When you’re discharged from the hospital after an injury or a new illness, your doctor will determine whether you need additional care. This decision is based on whether you can take care of yourself at home, whether you have help available at home, and what kind of care you need for your medical condition.

If you need special therapies or treatments to recover or if your condition requires professional or trained help, the doctor may say you need skilled nursing care.

Medicare’s coverage for skilled nursing facilities is broken down into benefit periods. A benefit period begins the day you’re admitted as an inpatient to the hospital or skilled nursing facility.

Different amounts are paid throughout the benefit period. The benefit period ends when 60 days in a row have passed without a need for hospital or skilled nursing care. If you go back to the hospital after that 60-day window, a new benefit period begins.

Here are the costs that apply throughout the benefit period:

  • Days 1 through 20: Medicare covers the entire cost of your care. You will pay nothing.
  • Days 21 through 100: Medicare covers most of the cost, but you’ll owe a daily copayment. In 2020, this copayment is $204 per day.
  • Day 101 and beyond: Medicare does not cover skilled nursing facility costs beyond day 100. At this point, you’re responsible for the entire cost of care.

While you’re staying in a skilled nursing facility, there are some exceptions to what is covered, even within the first 20-day window.

Items and services covered by Medicare

  • a semiprivate room (unless a private room is medically necessary)
  • meals
  • transportation for medical services not available at the skilled nursing facility
  • skilled nursing care
  • medical supplies used in the skilled nursing facility
  • medications
  • meals and dietary counseling
  • physical therapy, if needed
  • occupational therapy, if needed
  • speech therapy, if needed
  • medical social services

Items and services NOT covered by Medicare

  • additional telephone or television charges not covered by the facility
  • private-duty nursing services
  • personal hygiene items such as razors and toothpaste

There are some additional rules about Medicare coverage that you should know, including the following:

  • Your doctor can request additional services on your behalf that aren’t typically covered by Medicare. You may have to pay for these services yourself.
  • If you leave the skilled nursing facility and need to return within 30 days, you can do so without starting a new benefit period.
  • Medicare coverage will not pay for long-term care. Long-term care can include custodial care, which is when you need help with your daily activities but don’t need a medical professional, and assisted living, which is a residential setting that sometimes offers medical care as well.

Skilled care is nursing or therapy services that must be performed by or supervised by a professional. This may include wound care, physical therapy, IV medication administration, and more.

Skilled nursing facilities can be located within hospital units, but these are the minority. Most skilled nursing facilities are stand-alone, private, for-profit businesses. They usually provide many types of services, such as short-term medical care, rehabilitation, and long-term care.

Tip

Medicare offers an online tool to help you find approved skilled nursing facilities. Case managers and social workers can also help you with coverage for your hospital or skilled nursing facility stay.

Medicare will also cover rehabilitation services. These services are similar to those of skilled nursing but involve intensive rehabilitation, ongoing medical care, and coordinated care from doctors and therapists.

Medicare covers the same items and services in a rehabilitation facility (e.g., a shared room, meals, medications, therapies) as in a skilled nursing facility. The same exclusions (e.g., television, phone services, and personal hygiene items) apply.

You may need inpatient rehabilitation for a brain injury that requires both neurological and physical therapies or for another type of traumatic injury that affects multiple systems within your body.

The amount of coverage for inpatient rehabilitation is a little different from the amount for skilled nursing. Medicare Part A costs in 2024 for each benefit period are:

  • Days 1 through 60: A deductible applies to the first 60 days of care, which is $1,632 for rehabilitation services.
  • Days 61 through 90: You’ll pay a daily coinsurance of $204.
  • Days 91 and beyond: After day 90 for each benefit period, there is a daily coinsurance of $816 per “lifetime reserve day” (60 additional days of coverage that can be used only once during your lifetime).
  • After lifetime reserve days: You must pay all costs of care after you’ve used your lifetime reserve days.

You won’t usually have to pay a deductible for inpatient rehabilitation care if you paid a deductible for care during a previous hospitalization in the same benefit period. Your benefit period starts on the first day of a previous hospital stay. Each day of that hospital admission counts toward your deductible for inpatient rehabilitation care as well.

You will not pay a deductible for inpatient rehabilitation care that occurs if you are:

  • admitted to an inpatient rehabilitation facility within 60 days of being discharged from a hospital
  • transferred directly to an inpatient rehabilitation facility from an acute care hospital

In addition to Medicare Advantage and Medigap plans, there are a number of public and private programs that can help pay for skilled nursing costs. Here are a few examples:

A few last tips
  • If you think you may need skilled nursing care after a hospital stay, talk with your doctor early.
  • Make sure you’re listed as an inpatient, not an observation patient, during your admission.
  • Ask your doctor to document any information that would prove skilled nursing care is necessary for your condition.
  • Consider hiring a geriatric care manager to help plan your care needs and coordinate coverage.
  • If you’re able to go home and you have someone to help you there, Medicare will cover certain at-home therapies.
  • Before choosing a Medicare plan, review the different program options and consider what kind of coverage you may need in the future.
  • Check to see whether you qualify for Medicaid assistance in your state or for other public and private assistance programs.

Medicare will pay for short-term care in skilled nursing or rehabilitation facilities. The amount covered depends on your condition, how long you need care, and what supplemental insurance products you have.

Medicare will not pay for long-term care. It’s important to consider your future healthcare needs when you sign up for Medicare so you can weigh your program options.