Post-hospital care guide
Medicare Skilled Nursing Facility Coverage
Original Medicare can cover short-term skilled nursing facility care, but only when the hospital-stay, timing, skilled-need and facility requirements are satisfied.
Eligibility
The usual Original Medicare checklist
- Qualifying inpatient stay. You generally need at least three consecutive inpatient hospital days, not counting discharge day.
- Timely admission. You generally enter the skilled nursing facility within 30 days after leaving the hospital.
- Daily skilled need. A physician determines that you need daily skilled nursing or therapy for the hospital-treated condition or a condition that arose in the facility.
- Therapy can be part of skilled care. PT, OT and speech-language pathology may be included in a covered SNF stay. For outpatient and other therapy settings, see Medicare Therapy Coverage.
- Certified facility. The skilled nursing facility must participate in Medicare.
- Available benefit days. You must have days remaining in the benefit period.
2026 costs
What the 100-day benefit can cost
| Days in the benefit period | 2026 Original Medicare cost |
|---|---|
| Days 1–20 | $0 daily coinsurance after the applicable Part A hospital deductible |
| Days 21–100 | $217 per day |
| Day 101 and later | All costs |
A Medicare Supplement, employer coverage, Medicaid or Medicare Advantage plan can change what you personally pay. Verify the exact policy.
Coverage details
Three SNF Rules That Commonly Cause Confusion
Improvement Is Not the Only Test
Skilled care can be covered when it is needed to maintain a condition or prevent or slow deterioration, not only when improvement is expected. The service still must require the skills of qualified personnel and be reasonable and necessary. Custodial help alone does not qualify.
Hospital Status Matters
Observation time is outpatient care and generally does not count toward the three-day inpatient requirement. Ask the hospital to confirm status throughout the stay and keep the Medicare Outpatient Observation Notice if one is provided.
Medicare Advantage Rules Can Differ
A Medicare Advantage plan must cover medically necessary skilled nursing facility care, but it may use networks, prior authorization and plan-specific cost sharing. Some plans waive the three-day inpatient requirement. Obtain authorization and verify that the facility is in network before transfer whenever the situation permits.
Frequently asked questions
Skilled Nursing Coverage Questions
Does Medicare guarantee 100 days?
No. One hundred days is the maximum in a benefit period. Coverage can end earlier when skilled care is no longer medically necessary or another requirement is not met.
Does observation count toward the three inpatient days?
No, not under the usual Original Medicare rule. Observation is outpatient status.
Does Medicare cover room and board in a nursing home?
Only during a covered skilled nursing facility stay. It does not cover room and board when custodial long-term care is the only need.
What if I disagree when SNF coverage is ending?
Read the Notice of Medicare Non-Coverage and follow its fast-appeal instructions immediately. Deadlines can be very short.
Primary references
Official Sources
- Medicare.gov: Skilled nursing facility care
- CMS: 2026 Part A skilled nursing coinsurance
- Medicare.gov: Fast appeals
Reviewed against official sources on August 22, 2026. Medicare and state program rules can change; verify current requirements before acting.
Independent Medicare guidance
Make the Next Decision With the Actual Details in Front of You
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Thompson Medicare Brokerage is not connected with or endorsed by the U.S. government or the federal Medicare program. This page provides general educational information. Coverage, costs, eligibility, networks, formularies and enrollment rights depend on individual facts, location, plan and coverage year. Thompson Medicare Brokerage does not offer every plan available in every area; Medicare.gov, 1-800-MEDICARE and SHIP can provide information about all available options.