How Many Days Does Medicare Cover in a Rehab Facility?
Demystify Medicare's coverage for skilled nursing facility stays. Learn the nuances of eligibility and the limits of covered rehabilitation days.
Medicare, the federal health insurance program, covers certain rehabilitation services for eligible individuals. Understanding this coverage, particularly for stays in rehabilitation facilities, can be complex. This guide clarifies how Medicare assists with care in skilled nursing facilities, often referred to as rehab facilities, and the conditions under which this support is provided.
Medicare’s Coverage for Skilled Nursing Facilities
Medicare Part A, known as Hospital Insurance, covers care in a skilled nursing facility (SNF) under specific circumstances. This coverage is distinct from general long-term care, assisted living, or custodial care, which typically involves assistance with daily activities rather than medical treatment. SNF care is designed for short-term, medically necessary services that require the skills of trained professionals.
The services covered in an SNF include skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services. Medicare’s coverage for SNF care helps individuals recover from a recent illness or injury that necessitated a hospital stay, preparing them to return home or to a lower level of care.
Qualifying for Skilled Nursing Facility Coverage
To receive Medicare Part A coverage for a stay in a skilled nursing facility, an individual must meet several specific criteria. A primary requirement is a “qualifying inpatient hospital stay”: a medically necessary inpatient hospital stay of at least three consecutive days. This three-day count begins on the day of admission as an inpatient, but does not include the day of discharge. Time in the emergency room or under observation status does not count toward this three-day inpatient requirement.
Following the qualifying hospital stay, the individual must be admitted to a Medicare-certified skilled nursing facility within 30 days of their hospital discharge. A doctor’s order for daily skilled nursing care or skilled therapy services is also necessary. The skilled care received in the SNF must be for a condition treated during the qualifying hospital stay, or a new condition that developed while receiving SNF care for the original condition. The care must be medically necessary to improve, maintain, or prevent a decline in the individual’s condition.
The Medicare Benefit Period and Covered Days
Medicare Part A covers skilled nursing facility stays in “benefit periods.” A benefit period begins when an individual is admitted as an inpatient to a hospital or skilled nursing facility. This period ends when the individual has not received inpatient hospital or skilled SNF care for 60 consecutive days. There is no limit to the number of benefit periods an individual can have, but a new benefit period typically requires a new Part A deductible.
Within each benefit period, Medicare Part A covers SNF care for up to 100 days, assuming eligibility criteria continue to be met. For the first 20 days of an SNF stay, Medicare covers 100% of approved costs, with no co-insurance for the beneficiary. From day 21 through day 100, a daily co-insurance applies. For 2025, this daily co-insurance is $209.50. Beyond day 100 in a benefit period, Medicare Part A SNF coverage ends, and the individual becomes responsible for all costs.
Navigating Care Beyond the Initial Coverage
When Medicare Part A coverage for skilled nursing facility care ends, either after 100 days within a benefit period or if the individual no longer meets the criteria for skilled care, individuals face financial considerations. The individual generally becomes responsible for the full cost of their continued stay, often referred to as private pay.
Medicare Supplement Insurance, also known as Medigap, can help cover the co-insurance for days 21 through 100 of an SNF stay. Some Medigap plans may also provide limited additional coverage after day 100, depending on the specific plan purchased. Medicaid is another option for individuals who meet its strict financial eligibility requirements, often covering long-term care services for those with limited income and assets.
If an individual leaves a skilled nursing facility and later requires skilled care, a new benefit period might begin. This occurs if they have been out of a hospital or SNF for at least 60 consecutive days and then meet all initial qualifying criteria, including a new qualifying hospital stay. This allows for another period of Medicare Part A SNF coverage, up to 100 days, subject to medical necessity and benefit period rules.