What happens to my Medicare coverage if I enter a skilled nursing facility for rehab but then need long-term care?

Question

Leslie Kaz · Accepted Answer

When you enter a skilled nursing facility (SNF) for rehab, Medicare Part A typically covers up to 100 days per benefit period, provided you meet eligibility requirements (e.g., a qualifying 3-day hospital stay, skilled care needs, and admission within 30 days of hospital discharge). Here’s how it breaks down:

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.

Gary Church · Answer

Medicare covers skilled nursing facilities for rehab. Medicare does not cover long-term care. Depending on your income level, you may qualify for Medicaid assistance for LTC.

Paul Potter · Answer

Medicare doesn't cover long term care.  It does cover medical conditions while on long term care.

Based on the federal deficit, don't expect it to get any better.

Robert Vaughan, R.Ph., MBA · Answer

As long as you continue to pay your Medicare premiums nothing will happen to your Medicare coverage, but Medicare does not pay for long-term care. You will be responsible for 100% of the cost of your long-term care.

Answered by Robert Vaughan, R.Ph., MBA on May 6, 2025

Broker Licensed in CA, AZ, NM, NV & TX

Answered by Robert Vaughan, R.Ph., MBA Medicare Insurance Agent

Joel Gregory Craven · Answer

All Medicare advantage carriers follow most of the same rules as original Medicare, however each carrier sets their plan with different copays and numbers of day which that copay applies. Some folk switch out of their Medicare advantage plan when they enter the long term care facility. Please don’t confuse rehab (swing bed hospital) with long term custodial care. If the member needs help with activities of daily living like dressing eating bathing etc ….that is not medical…. That’s total custody of the persons wellbeing care survival feedings etc. Total custody would be covered under a long term care policy or State Medicaid if they are low income, but not Medicare or a medical policy. There is a special election SEP for being institutionalized in a rehab or long term care facility. Then when they move out of the rehab or LTCF, they will generally have a new SEP to enroll back in a mapd. Always contact your agent and get them to help you navigate your plan options. Feel free to reach out to our agency which is licensed and appointed in many states and will consider getting set up in your state to help you be one of our wonderful customers!!!

Answered by Joel Gregory Craven on August 4, 2025

Broker Licensed in MS, AL, AZ & 5 other states

Answered by Joel Gregory Craven Medicare Insurance Agent

Michael Pyers · Answer

Skilled nursing is only for 100 days. After that, if you need long term care it entirely at your expense. Several options - if you had long term care insurance, it would pay at least part of your stay. If not, and you have limited resources the state may pay for the stay through Medicaid.

Answered by Michael Pyers on August 20, 2025

Broker Licensed in OH & MI

Answered by Michael Pyers Medicare Insurance Agent

Becki Jennings · Answer

Medicare has a Skilled Nursing Facility benefit up to 100 days per benefit period. Once the Skilled Nursing Benefit has been exhausted, the patient will need to arrange payment outside of Medicare coverage. This may mean Medicaid, Long-Term Care Coverage, or Private Pay.

Answered by Becki Jennings on June 4, 2025

Agent Licensed in MO

Answered by Becki Jennings Medicare Insurance Agent

Cody Brown · Answer

Medicare does not cover long term care. If you are transitioned from skilled nursing to long term care, you would need to use outside insurance or self pay.

Angie Templin · Answer

Medicare can help to pay for care up to 100 days as long as there is a recovery plan. If no recovery is possible or if your stay exceeds 100 days, you will be cosidered self pay. Lower income persons may qualify for benefits under your state's Medicaid program

Answered by Angie Templin on May 5, 2025

Broker Licensed in TX

Answered by Angie Templin Medicare Insurance Agent

Fred Manas · Answer

If you initially enter a skilled nursing facility for rehabilitation under Medicare Part A, and then your needs transition to requiring long-term care, your Medicare coverage will likely end after the 100-day benefit period, unless other specific conditions are met. Medicare generally does not cover long-term care needs, such as custodial care or chronic care, in a skilled nursing facility. 
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.

Gary Henderson · Answer

As always, you should specify whether you have a Medicare advantage plan or Medicare supplement plan 
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

Marcie Barnes · Answer

Long term care is not covered by Medicare.

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.

Suzanne Lamperti · Answer

You MUST have Part A and a qualifying  impatient hospital stay. This is covered for a short period of time. Medicare does NOT cover long term care. You should consider long term care insurance.

Linda Davies · Answer

Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don’t pay for long-term care. This type of care (also called “custodial care” or “long-term services and support”) includes medical and non-medical care for people who have a chronic illness or disability. 

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.

Shahwali Hotaki · Answer

Medicare covers up to 100 days of skilled nursing care after a hospital stay—only for rehab, not long-term custodial care. If you need help with daily living beyond that, Medicare stops paying, and you’d need to pay out-of-pocket or apply for Medicaid.

Answered by Shahwali Hotaki on August 5, 2025

Agent Licensed in CA, GA & VA

Answered by Shahwali Hotaki Medicare Insurance Agent

Rachael Metcalf · Answer

Nothing happens to your medicare coverage. Skilled Nursing has a limit of 100 days. Medicare does not cover long term care..... that is what a long-term care plan is for.

Robert Barco · Answer

Medicare will cover the skilled nursing facility, but Medicare part A coverage will end once Long -Term Care starts. You will be responsible for all Long-Term Care costs unless you have Long-Term Care insurance or qualify for Medicaid.

Answered by Robert Barco on May 6, 2025

Broker Licensed in OH

Answered by Robert Barco Medicare Insurance Agent

Nicolas Cain · Answer

Medicare covers skilled nursing facility (SNF) rehab for up to 100 days if you meet certain criteria (like a prior 3-day hospital stay). But it does not cover long-term custodial care in a nursing home.

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!

Gabrielle Sones · Answer

Depending on your plan you should have a benefit for Skilled nursing facility and or home health care. I would speak to your carrier. I would also work with a broker to see what kind of additional protection you can add onto your coverage for these specific situations to help protect you more than what Medicare offers.

Answered by Gabrielle Sones on May 13, 2025

Broker Licensed in TX, AZ, FL & 7 other states

Answered by Gabrielle Sones Medicare Insurance Agent

Jim Towle · Answer

If you enter a skilled nursing facility (SNF) for rehabilitation but then need long-term care, your Medicare coverage will change depending on the type and duration of care you require. Here’s what happens step by step:

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.

What happens to my Medicare coverage if I enter a skilled nursing facility for rehab but then need long-term care?

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What happens to my Medicare coverage if I enter a skilled nursing facility for rehab but then need long-term care?

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