How Long Medicare Part A Pays 100% for a Skilled Nursing Facility

Medicare Part A provides healthcare coverage, especially for medical needs following a hospital stay. This federal health insurance program offers assistance with costs associated with inpatient hospital care, certain home health services, hospice care, and skilled nursing facility (SNF) care. Understanding Medicare Part A’s provisions for SNFs becomes important for managing post-acute care for individuals needing rehabilitative or skilled medical services after hospitalization.

Understanding Medicare Part A Coverage for Skilled Nursing Facilities

A Skilled Nursing Facility (SNF) provides medical and rehabilitative services with professional staff, including doctors, registered nurses, and various therapists. These facilities differ from traditional nursing homes, which primarily offer custodial care like assistance with daily activities. Medicare Part A covers SNF care when it involves “skilled nursing care” or “skilled therapy services,” which must be provided or supervised by licensed medical professionals.

Skilled nursing care includes services like intravenous injections, wound care, and medication administration. Skilled therapy services include physical therapy, occupational therapy, and speech-language pathology, all aimed at improving, maintaining, or slowing the decline of a patient’s condition. The services Medicare Part A can cover within an SNF setting are comprehensive, and typically include a semi-private room, meals, skilled nursing care, and medically necessary therapies.

Coverage also includes medications, medical supplies, and equipment used within the facility. If medically necessary services are not available at the SNF, ambulance transportation to the nearest qualified provider may also be covered. This coverage is for short-term stays, intended for recovery and rehabilitation after an illness or injury, rather than long-term custodial care.

Qualifying for Medicare Part A Skilled Nursing Facility Coverage

To qualify for Medicare Part A SNF coverage, specific criteria must be met. A primary requirement is a “qualifying inpatient hospital stay” of at least three consecutive days. This means the beneficiary must be formally admitted as an inpatient for three days, not counting the day of discharge. Time spent in the emergency room or under “observation status” does not count towards this three-day inpatient requirement, even if it includes an overnight stay. Confirming inpatient admission status is important, as it affects SNF coverage eligibility.

A doctor must also order daily skilled nursing care or therapy services. This care must be medically necessary for a condition treated during the qualifying hospital stay, or for a new condition arising while receiving SNF care for the hospital-related condition. The care must be provided by or under the supervision of skilled nursing or therapy staff, and only given in an SNF on an inpatient basis. Medicare’s focus is on the need for skilled services to improve, maintain, or prevent the decline of a patient’s condition.

Admission to the SNF must generally occur within 30 days of leaving the hospital. If a beneficiary re-enters the same or another SNF within 30 days, a new three-day qualifying hospital stay may not be required for continued benefits, provided all other conditions are met. The SNF must also be certified by Medicare to be eligible for coverage.

Duration and Costs of Medicare Part A Skilled Nursing Facility Coverage

Once qualified, Medicare Part A covers Skilled Nursing Facility care based on a “benefit period.” A benefit period begins the day a beneficiary is admitted as an inpatient to a hospital or SNF. It concludes when the beneficiary has not received any inpatient hospital or skilled nursing facility care for 60 consecutive days. There is no limit to the number of benefit periods an individual can have, but a new benefit period requires payment of the Medicare Part A hospital deductible if one was not paid for a hospital stay within the same benefit period.

Medicare Part A pays 100% of approved costs for the initial part of a covered SNF stay. This full coverage applies for the first 20 days within each benefit period. During this period, beneficiaries typically pay nothing for covered services. This 20-day period begins after all qualifying conditions, such as the three-day inpatient hospital stay and medical necessity, have been met.

Following the first 20 days, the cost-sharing structure changes. From day 21 through day 100 of a covered SNF stay within a benefit period, the beneficiary is responsible for a daily coinsurance amount. For 2025, this daily coinsurance is $209.50. Medicare Part A covers the remaining approved costs during this period. After day 100 in a benefit period, Medicare Part A does not provide further coverage for SNF care, and the beneficiary becomes responsible for all costs.