How Long Will Medicare Pay for Skilled Nursing?
Understand the scope of Medicare's skilled nursing facility coverage. Learn about time limits, qualifying conditions, covered care, and planning for ongoing needs.
Medicare Part A may provide coverage for skilled nursing facility (SNF) care, a specialized support for individuals needing daily skilled nursing or rehabilitation services. An SNF is equipped to deliver these services, such as intravenous medications or physical therapy. This coverage is distinct from long-term custodial care, which primarily involves assistance with daily activities and is not generally covered by Medicare.
Meeting Requirements for Coverage
For Medicare Part A to cover skilled nursing facility care, specific conditions must be met. A primary requirement is a “qualifying hospital stay,” meaning a medically necessary inpatient hospital stay of at least three consecutive days. Time spent under observation status or in the emergency room before formal inpatient admission does not fulfill this requirement.
Following the qualifying hospital stay, a beneficiary must be transferred to a Medicare-certified skilled nursing facility within 30 days of hospital discharge. The care received at the SNF must be medically necessary, requiring daily skilled nursing care or skilled therapy services, such as physical, occupational, or speech-language pathology. This care must be ordered by a physician and address a condition treated during the qualifying hospital stay, or a new condition that developed while receiving SNF care for the initial condition. The facility itself must be recognized as a Medicare-certified SNF.
Understanding the Coverage Period
The duration of Medicare’s payment for skilled nursing facility care is tracked using a “benefit period.” This period begins the day a beneficiary is admitted as an inpatient to a hospital or a skilled nursing facility and concludes when they have not received inpatient hospital care or skilled nursing care for 60 consecutive days. While there is no limit to the number of benefit periods a beneficiary can have, each new period requires meeting the initial qualifying criteria, including a new qualifying hospital stay.
Within a benefit period, Medicare’s coverage for SNF care is tiered. For the first 20 days of care, Medicare typically covers 100% of approved costs, meaning beneficiaries pay nothing. From day 21 through day 100, beneficiaries are responsible for a daily copayment, with Medicare covering the remaining approved costs. In 2025, this daily copayment is $209.50. Beyond day 100 in a benefit period, Medicare pays nothing, and the beneficiary becomes responsible for all costs. Medicare coverage for SNF care will cease if the patient no longer requires daily skilled care, even if the 100-day maximum has not been reached.
Services Included in Coverage
When a beneficiary meets the eligibility criteria and is within the covered duration, Medicare Part A provides coverage for a range of specific services within a skilled nursing facility. This typically includes a semi-private room and meals.
The core of the coverage lies in skilled medical services. This encompasses skilled nursing care, including procedures like wound care, intravenous medication administration, or catheter care. Physical therapy, occupational therapy, and speech-language pathology services are covered if needed to meet the patient’s health goals. Additionally, Medicare covers medications administered within the SNF, medical supplies, and equipment used during the stay. Dietary counseling and medically necessary ambulance transportation to the nearest facility for services not available at the SNF are also included.
Medicare generally does not cover private duty nursing, a private room (unless medically necessary), personal convenience items such as telephone or television, or long-term custodial care that does not require skilled services.
Options When Coverage Ends
When Medicare’s skilled nursing facility coverage concludes, either due to exhausting the 100 days within a benefit period or because daily skilled care is no longer medically necessary, beneficiaries face several options for continued care and payment. One direct option is self-pay, where the individual becomes responsible for 100% of the facility costs if they wish to remain for non-skilled care or if their skilled need has ceased.
Medicaid may offer an alternative for those who meet specific income and asset limitations. Medicaid is a joint federal and state program that can cover long-term care costs, but eligibility criteria can vary significantly by state and typically require a spend-down of assets. Another avenue is long-term care insurance, if a beneficiary has such a policy in place. These private insurance plans are designed to cover services like skilled nursing care after Medicare coverage ends.
Beneficiaries also have the right to appeal if they believe their Medicare coverage is ending prematurely while they still require skilled care. They will typically receive a Notice of Medicare Non-Coverage (NOMNC) and can initiate a “fast appeal” to an independent reviewer to challenge the decision.