Medicare Coverage for Skilled Nursing: How It Works After a Hospital Stay

Medicare can help pay for skilled nursing facility (SNF) care, but only under specific conditions. Many people assume Medicare will cover long-term nursing home care, but that’s not true. The coverage is limited, and it's important to understand when it applies & when it doesn’t.

This article breaks down exactly how Medicare covers skilled nursing after a hospital stay, who qualifies, how long the coverage lasts, and what costs you can expect.

What Is Skilled Nursing Care?

Skilled nursing care refers to medically necessary services provided by licensed health professionals, such as registered nurses, physical therapists, or occupational therapists. These services must be ordered by a doctor and are typically required after a hospitalization due to surgery, injury, or a serious illness. Skilled care includes things like wound treatment, IV therapy, physical rehabilitation, and other treatments that require a clinical setting. It is important to note that this is not the same as custodial care, which includes assistance with daily activities like bathing, eating, or dressing. Custodial care is not covered by Medicare.

When Medicare Covers Skilled Nursing Facility (SNF) Care

To qualify for Medicare coverage of skilled nursing care, five conditions must be met:

1. You Have Medicare Part A

Medicare Part A covers inpatient hospital stays and skilled nursing facility care. You must be enrolled in Part A for coverage to apply.

2. You Had a Qualifying Inpatient Hospital Stay

You must have been admitted as an inpatient for at least three consecutive days (not counting the discharge day).
Observation status does not count, even if you stayed overnight in a hospital bed.

3. You Enter the SNF Within 30 Days of Hospital Discharge

You need to transfer to the skilled nursing facility within 30 days after leaving the hospital.

4. You Need Skilled Care

Your condition must require daily skilled services that can only be provided in a SNF setting.

5. The Facility Is Medicare-Certified

The SNF must be approved by Medicare. Not all facilities are.

What Medicare Pays For (and How Long)

When all Medicare requirements are met, Medicare Part A will cover the cost of care in a skilled nursing facility. This includes room and board in a shared room, meals, skilled nursing services, physical and occupational therapy, speech-language pathology services, medications, and medical supplies needed during the stay. However, the coverage does not last indefinitely. Medicare pays the full cost for the first 20 days. From day 21 through day 100, Medicare continues to cover part of the cost, but you are responsible for a daily copayment. After 100 days, Medicare coverage ends entirely, and you become responsible for the full cost of the stay.

The coverage is time-limited, and is often outlined as a hidden expense that people don’t think about until it’s too late. Here are some details on what you can expect…

Note: These numbers are for Original Medicare in 2025. Medicare Advantage plans may vary.

Common Reasons People Lose Coverage

There are several situations that can cause Medicare to stop covering skilled nursing care. One of the most common is when a patient’s condition improves to the point that daily skilled care is no longer medically necessary. In these cases, Medicare will determine that continued skilled care is not justified and will discontinue payment. Coverage also ends automatically after 100 days in a benefit period. Additionally, if a patient voluntarily leaves the facility for an extended period or begins receiving only custodial care, Medicare will no longer provide coverage. It’s also possible to lose coverage if a patient refuses treatment or fails to follow the care plan outlined by their healthcare provider.

What About Medicare Advantage Plans?

If you're enrolled in a Medicare Advantage plan instead of Original Medicare, your skilled nursing facility benefits may look slightly different. While Medicare Advantage is required to offer the same core benefits as Original Medicare, the plan may impose additional rules, such as requiring prior authorization before entering a facility. Copay amounts and coverage timelines can also differ from the standard Medicare structure. Another key difference is the use of provider networks; Medicare Advantage plans often have a limited list of approved skilled nursing facilities, and receiving care outside that network could result in higher costs or denied coverage. It’s important to review your plan details carefully and confirm coverage with your insurer before a skilled nursing admission.

Tips to Protect Yourself

• Get documentation: Ensure your hospital stay qualifies as “inpatient” — not just “under observation.”

• Ask the facility: Confirm the nursing facility is Medicare-certified.

• Track your days: Keep count of how many days you’ve used in a benefit period.

• Talk to an agent: A licensed Medicare advisor can help you understand your coverage or look at Medigap options to reduce costs.

Final Thoughts

Medicare does provide skilled nursing coverage — but only under narrow conditions and for a limited time. It’s critical to understand the rules so you’re not caught off guard by high out-of-pocket costs. If you’re unsure about your eligibility or want to compare plans that offer better post-hospital coverage, consider speaking with a licensed Medicare agent.