What happens to my Medicare coverage if I enter a skilled nursing facility for rehab but then need long-term care?
Answered by 17 licensed agents
Days 1–20: Medicare covers the full cost of SNF care (assuming the facility is Medicare-certified and care is medically necessary).
Days 21–100: You pay a daily coinsurance ($204 in 2025), and Medicare covers the rest. Supplemental insurance (like Medigap) may cover this coinsurance.
After 100 days: Medicare Part A stops covering SNF care, regardless of whether you still need rehab or have transitioned to long-term care.
Answered by Leslie Kaz on May 6, 2025
Agent Licensed in CA, AL, AZ & 7 other states
Answered by Gary Church on July 8, 2025
Broker Licensed in Ca, AZ, NV & TX
Based on the federal deficit, don't expect it to get any better.
Answered by Paul Potter on May 5, 2025
Broker Licensed in FL
Answered by Robert Vaughan, R.Ph., MBA on May 6, 2025
Broker Licensed in CA, AZ, NM, NV & TX
Answered by Becki Jennings on June 4, 2025
Agent Licensed in MO
Answered by Cody Brown on May 5, 2025
Agent Licensed in MO, AR, AZ & 5 other states
Answered by Angie Templin on May 5, 2025
Broker Licensed in TX
Here's a more detailed breakdown:
Initial Medicare Coverage:
Part A:
Medicare Part A can cover up to 100 days of skilled nursing facility care in a benefit period, provided you meet certain criteria, including having a 3-day hospital stay prior to the SNF stay.
100-Day Benefit:
Medicare will generally cover the first 20 days with no copay, and then a coinsurance amount (currently $209.50 per day in 2025) for days 21-100.
Intensive Rehabilitation:
The coverage is intended for intensive rehabilitation and medical supervision, not for chronic or custodial care.
Transition to Long-Term Care:
Medicare Coverage Ends:
.
If your condition requires long-term care beyond the 100-day benefit period, Medicare coverage will typically stop.
Out-of-Pocket Costs:
.
You will be responsible for the cost of care in the SNF after the 100-day limit.
Medigap and Medicare Advantage:
.
Medigap policies can help cover out-of-pocket costs for Part A, but not if you're on a Medicare Advantage plan.
Options for Long-Term Care:
Medicaid:
You may be eligible for long-term care through Medicaid, which has different eligibility requirements and coverage.
Private Long-Term Care Insurance:
Consider private insurance policies to help cover the costs of long-term care.
Other Programs:
Explore other public and private programs that may offer financial assistance for skilled nursing facility costs, such as PACE programs.
Answered by Fred Manas on May 5, 2025
Agent Licensed in NY, CT, DC & 7 other states
The Medicare advantage plan you're going to pay a certain amount everyday starting day 21 through 100
With Medicare supplement plans, you pay nothing up to 100 days
If you go into a nursing home that is not covered by Medicare other than normal medical coverage does not pay for long-term care. At that point you'll have to look at different options, possibly Medicaid. If your income is low cuz they will typically take your social security payment to pay part of the bill and the rest would probably come from Medicaid, they can only take half of your financial assets. If you're married, they cannot touch your house or a car. If you're married, it's a complex issue, not a simple one to explain
Answered by Gary Henderson on June 24, 2025
Agent Licensed in TX, AK, AL & 46 other states
2 things you need to think about when it comes to long term care.
1. Buy a long term care policy. Depending on your age it could be quite expensive, but worth looking into
2. If Long term care is needed. Liquidation of all your assets and apply for Medicaid once you have exhausted all your resources.
Answered by Marcie Barnes on June 26, 2025
Agent Licensed in TX, AK, AL & 48 other states
Answered by Suzanne Lamperti on May 20, 2025
Broker Licensed in MD
Most long-term care isn’t medical care. Instead, most long-term care helps with basic personal tasks of everyday life, sometimes called “activities of daily living.” This may include:
Help with personal care assistance (like dressing, bathing, and using the bathroom)
Home-delivered meals
Adult day health care
You might qualify for long-term care through Medicaid, or you can choose to buy private long-term care insurance.
You can get non-medical long-term care services at home, in the community, in an assisted living facility, or in a nursing home. It’s important to start planning for non-medical long-term care now to maintain your independence and make sure you get the care you may need, in the setting you want, now and in the future. If you’re an American Indian or Alaska Native, contact your local Indian health care provider for more information.
Answered by Linda Davies on June 3, 2025
Broker Licensed in IL
Answered by Rachael Metcalf on May 5, 2025
Agent Licensed in TN, FL, GA & 5 other states
Answered by Robert Barco on May 6, 2025
Broker Licensed in OH
Answered by Gabrielle Sones on May 13, 2025
Broker Licensed in TX, AZ, FL & 7 other states
If you need long-term care after rehab, you’ll likely need to pay out-of-pocket, use Medicaid (if eligible), or consider long-term care insurance.Which we can also help you with!
Answered by Nicolas Cain on July 24, 2025
Agent Licensed in SC
1. Medicare Coverage for Skilled Nursing Facility (SNF) Care (Rehabilitation)
When you first enter a skilled nursing facility for rehabilitation following a hospital stay, Medicare Part A (hospital insurance) will typically cover your care under certain conditions. For Medicare to cover SNF care:
You must have been hospitalized for at least three consecutive days before being admitted to the skilled nursing facility.
Your doctor must certify that you need skilled nursing care (e.g., physical therapy, occupational therapy, or other skilled services) on a daily basis to improve or maintain your condition.
For the first 20 days, Medicare covers the full cost of your SNF care. After that, for days 21 through 100, you are responsible for a daily coinsurance (which in 2025 is $200 per day), and Medicare will cover the rest. Beyond 100 days, Medicare will no longer cover the cost of your care in the SNF, and you will be responsible for the full cost.
2. Transitioning from Short-Term Rehab to Long-Term Care
If you enter the SNF for rehabilitation, but during that time it becomes clear that you need long-term care (e.g., assistance with daily activities such as bathing, dressing, or eating), Medicare will stop covering your care after the 100-day limit if you continue to stay at the facility. Medicare is designed to cover only short-term, medically necessary rehabilitation, not long-term custodial care.
For long-term care, you’ll need to explore other payment options:
2.1. Medicaid
Medicare does not cover long-term care for individuals who need it for an extended period, but Medicaid may be available for those who qualify based on their financial situation. Medicaid provides coverage for long-term care in a skilled nursing facility.
Answered by Jim Towle on July 31, 2025
Agent Licensed in AL
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