What is the Medicare Advantage 3 midnight rule?

Question

Larry Dalton · Accepted Answer

The 3-midnight rule, or sometimes called the 3-day rule, is a Medicare requirement for skilled nursing facility (SNF) coverage.  Your Medicare beneficiary must have an inpatient hospital stay of 3 consecutive days in a hospital before Medicare will cover a stay in an SNF.  

Remember that the day you go into the hospital counts, but not the day of discharge, on these 3 days.

Misty Bolt · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/what-is-the-medicare-advantage-3-midnight-rule#misty-bolt

Bill Wheeler · Answer

•   You must have a 3-night inpatient hospital stay (not including the discharge day or time in observation status).
   •   SNF care must start within 30 days of hospital discharge.
   •   The care must be medically necessary and related to the hospital stay.

Under Medicare Advantage:
   •   Most Medicare Advantage (MA) plans follow the same 3-midnight rule.
   •   However, some MA plans waive the rule and allow SNF care without a 3-night inpatient stay.

Richard Moreno · Answer

The medicare advantage 3 midnight rule refers to inpatient skilled nursing requirement. You must be in an inpatient hospital for three days to be referred to a skilled nursing facility.

Justin Doherty · Answer

The 3-midnight rule is a common requirement that a plan member be admitted as an in-patient in a hospital for 3 full days (3 overnights) before being transferred to a Skilled Nursing Facility. In most cases, the plan will not cover the SNF stay if the plan member did not satisfy this (and other) requirements.

Answered by Justin Doherty on July 9, 2025

Broker Licensed in PA, CO, CT & 10 other states

Answered by Justin Doherty Medicare Insurance Agent

Mackenzie Anderson · Answer

Prior to being admitted to a Skilled Nursing Facility, the individual must have a minimum three-night stay in a hospital. If this requirement isn't met, Medicare Part A will not pay for the Skilled Nursing Facility.

Answered by Mackenzie Anderson on July 3, 2025

Agent Licensed in TX

Answered by Mackenzie Anderson Medicare Insurance Agent

Steven Bleicher · Answer

The rules of Medicare can be quirky. The midnight rule is when you are hospitalized. In order to qualify for a free transfer to a rehabilitation facility, the hospital knows to keep you for three days and then on the 4th day, an ambulance will transfer you to rehab since they want your bed for the next patient. Thus, the ambulance is free for the one-way trip and the rehab is also going to be free based on your doctor's "Plan of Care" which enumerates the # of days she/he believes is required for you to receive the proper treatments before they can release you to your home. Since the rehab facility follows those # of days, should you may need further exercises at home, you would need to ask your Medicare agent if there's a chance that added days of physical therapy are possibly going to be approved by your insurance, be it, your primary or secondary.

Answered by Steven Bleicher on July 13, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Diana Garner · Answer

This rule, also known as the 3-day rule, requires a Medicare beneficiary enrolled in an MA plan to have a hospital stay of 3 consecutive nights before Medicare will cover subsequent skilled nursing facility care.

Answered by Diana Garner on July 7, 2025

Broker Licensed in KY, FL, IN, OH & TN

Answered by Diana Garner Medicare Insurance Agent

Gary Henderson · Answer

The 3-midnight rule gets its name from how Medicare counts days. For a person to meet the requirements of this rule, they need to have 3 consecutive days of inpatient hospital care — not counting observation — before admission to an Skilled Nursing Facility for recovery. This can occur in one or more hospital facilities.

Answered by Gary Henderson on July 3, 2025

Agent Licensed in TX, AK, AL & 46 other states

Answered by Gary Henderson Medicare Insurance Agent

Deborah Webster · Answer

I believe you are referring to a rule with Medicare Advantage plans that requires a 3-day stay in the hospital before the plan will pay for skilled nursing care. This is the 3 midnight or after stay.
You can refer to your plan's evidence of coverage to see if this rule applies to your plan.

Toni Chavez · Answer

The 3-midnight rule in Medicare refers to a requirement for impatient hospital stays in relation to Skilled Nursing Facility coverage, not Medicare Advantage directly - but it still applies to most Medicare Advantage plans because they must provide benefits at least as good as Original Medicare 

How This Applies to Medicare Advantage:

Most Medicare Advantage plans follow this same rule because they are required to offer at least the same benefits as Original Medicare.

Some MA plans waive the 3-midnight rule, allowing SNF care without a prior hospital stay—but this varies by plan.

Check your plan’s Evidence of Coverage or Summary of Benefits to confirm.

What is the Medicare Advantage 3 midnight rule?

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