How Many Days Will Medicare Pay for Skilled Nursing Care?

Skilled Nursing Facilities (SNFs) provide medical care and rehabilitation services for individuals recovering from an illness, injury, or surgery. These facilities offer 24-hour nursing care and therapies to help patients regain functional abilities and safely transition back home or to a less intensive care setting. Medicare Part A can cover a portion of the costs associated with SNF care. This coverage, however, is subject to specific conditions and is limited in duration. This article clarifies how Medicare covers SNF services, detailing coverage length and associated patient costs.

Medicare’s Eligibility Criteria for Skilled Nursing Care

For Medicare Part A to cover skilled nursing facility care, beneficiaries must meet several requirements. A “qualifying hospital stay” means an inpatient hospital stay of at least three consecutive days, not including the day of discharge. This hospital stay must precede SNF admission, and the patient must be admitted to a Medicare-certified SNF within 30 days of hospital discharge.

SNF care must be for a condition treated during the hospital stay, or for a condition that developed while receiving SNF care for that condition. Another criterion is the need for daily “skilled care.” This refers to services complex enough to require the expertise of licensed healthcare professionals, such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, or speech-language pathologists.

Examples of skilled services include intravenous injections, complex wound care, or daily physical therapy to regain mobility. These services must be doctor-ordered and regularly reviewed for continued medical necessity. Medicare only covers care that cannot be safely and effectively provided in a less intensive setting, ensuring the SNF stay is appropriate for the patient’s medical needs.

The Medicare Skilled Nursing Facility Benefit Period

Medicare Part A structures its coverage for skilled nursing facility care within defined “benefit periods.” A benefit period begins on the first day a beneficiary receives inpatient hospital care or skilled nursing facility care and ends after they have been out of a hospital or a SNF for 60 consecutive days. If a patient requires SNF care again after this 60-day break, a new benefit period begins, potentially renewing eligibility for coverage.

Within each benefit period, Medicare Part A offers coverage for up to 100 days of skilled nursing facility care. For the initial 20 days, Medicare covers 100% of approved costs for covered services. This means beneficiaries incur no out-of-pocket expenses for medically necessary skilled care during this time.

From day 21 through day 100 of the benefit period, Medicare continues to pay a significant portion of costs, but the patient becomes responsible for a daily coinsurance amount. Medicare will only continue to cover these days if the patient consistently requires daily skilled nursing or therapy services. If the need for daily skilled care ceases, Medicare coverage will end, even if the 100-day limit has not been reached.

Your Out-of-Pocket Costs for Skilled Nursing Care

While Medicare Part A provides substantial coverage for skilled nursing facility care, beneficiaries are responsible for certain out-of-pocket expenses. During the first 20 days of a benefit period, Medicare pays the full approved cost for covered SNF services, meaning there is no coinsurance for the patient. However, from day 21 through day 100 of the benefit period, a daily coinsurance amount applies.

For calendar year 2025, the daily coinsurance for skilled nursing facility care is $209.50. This amount is subject to annual adjustments by the Centers for Medicare & Medicaid Services (CMS). Patients are responsible for this daily coinsurance for each day they receive skilled care between day 21 and day 100 of their benefit period.

Medicare does not cover all expenses associated with a SNF stay. Services such as personal care items, private duty nursing, or a private room (unless medically necessary) are not covered by Medicare. Some individuals may have supplemental insurance, such as Medigap policies, or be eligible for Medicaid, which can help cover these out-of-pocket costs, but these are separate programs with their own eligibility rules.

Ending of Medicare SNF Coverage

Medicare skilled nursing facility coverage ceases under two main circumstances, impacting when a beneficiary’s financial responsibility for care may increase. One reason is the exhaustion of benefits, which occurs when a patient has utilized all 100 days of coverage within a single benefit period. Once these 100 days are used, Medicare Part A no longer contributes to the cost of the SNF stay for that benefit period, and the patient becomes responsible for all subsequent costs.

Coverage also ends if the patient no longer requires daily skilled nursing or therapy services, even if days remain in their 100-day benefit period. Medicare’s coverage is specifically for skilled care, not for custodial care, which involves assistance with daily activities like bathing, dressing, or eating. If a patient’s need shifts to custodial care, Medicare coverage will terminate because the medical necessity for skilled services in a SNF setting is no longer met.

When Medicare coverage for SNF services is expected to end, the facility is required to provide the patient with a “Notice of Medicare Non-coverage” (NOMNC). This notice informs the beneficiary of the impending end of covered services and outlines their right to appeal the decision. The NOMNC must be delivered at least two calendar days before covered services are scheduled to end, or on the second to last day if care is not provided daily. After Medicare coverage concludes, patients may explore options such as private payment, long-term care insurance, or Medicaid, if eligible, to cover continued care needs.