Medicare Coverage of Skilled Nursing Facility Stays

A growing number of patients recovering from surgery or a major illness are referred by their doctors to skilled nursing facilities. These nursing facilities provide an important, less expensive alternative to hospitalization.

Medicare Part A may cover some of your costs of staying in a skilled nursing facility (SNF), but it strictly limits how much it will pay.

What Is Skilled Nursing Facility Care?

Skilled nursing facility care provides high levels of medical and nursing care, 24-hour monitoring, and intensive rehabilitation. It's intended to follow acute hospital care due to serious illness, injury, or surgery—and usually lasts only a matter of days or weeks.

What is a skilled nursing facility (SNF)? Skilled nursing facility care takes place in a hospital's extended care wing or in a separate nursing facility.

In contrast, most nursing homes provide what's called "custodial care"—which is primarily personal, nonmedical care for people who are no longer able to fully care for themselves. For the most part, custodial care amounts to assist with the tasks of daily life: eating, dressing, bathing, moving around, and some recreation. It usually involves some health-related matters such as monitoring and assisting with medication and providing some exercise or physical therapy. But custodial care is ordinarily provided by personnel who are not highly trained health professionals like registered or vocational nurses and doesn't involve any significant treatment for illness or physical condition.

Custodial care often lasts months or years, and is not covered at all by Medicare. Medicaid will pay for unskilled nursing home care for people with low income and assets. (For more information, read our article on when Medicaid will pay for a nursing home or assisted living.)

Skilled nursing facilities are sometimes called post-acute rehabilitation centers, but the rules for a stay in an acute care rehabilitation center, or inpatient rehab facility (IRF), are different. For more information, see our article on Medicare coverage of inpatient rehab facility stays.

When Does Medicare Cover Skilled Nursing Facility Care?

You must meet several requirements before Medicare will pay for any skilled nursing facility care:

• You must have Medicare Part A and have days left in your 100-day benefit period (see below).
• You must have recently stayed in a hospital for at least three days, where you were treated for the same condition for which you need ongoing skilled nursing or therapy care.
• Your doctor must verify that you require daily skilled nursing care or therapy care, and
• The skilled services provided by the SNF must be reasonable and necessary for the diagnosis and treatment of your condition.

Medicare used to require that your condition be expected to improve in order for skilled nursing care to be covered, but now Medicare will pay for skilled nursing care if it's needed to maintain your condition or to slow the deterioration of your condition.

Required Prior Hospital Stay

Your stay in a skilled nursing facility must follow at least three consecutive days, not counting the day of discharge, in the hospital. And you must have been actually "admitted" to the hospital, not just held "under observation."

In addition, your stay in the nursing facility must begin within 30 days of being discharged from the hospital. If you leave the nursing facility after Medicare coverage begins, but are readmitted within 30 days, that second period in the nursing facility will also be covered by Medicare.

Requiring Daily Skilled Nursing Care

Your doctor must certify that you require daily skilled nursing care or skilled rehabilitative services. This care can include rehabilitative services by professional therapists, such as physical, occupational, or speech therapists, or skilled nursing treatment that require a trained professional, such as giving injections, changing dressings, monitoring vital signs, or administering medicines or treatments.

If you're in a nursing facility only because you are unable to feed, clothe, bathe, or move yourself, your stay won't be eligible for Medicare Part A coverage, even though these restrictions are the result of your medical condition. This is because you don't require skilled nursing care as defined by Medicare rules. But if you require occasional part-time nursing care, you may be eligible for home health care coverage. For more information, see our article on Medicare's home health coverage.

What Does Medicare Cover When I Qualify for Skilled Nursing Care?

The nursing facility care and services covered by Medicare are similar to what's covered for hospital care. They include:

• a semiprivate room (two to four beds per room), or a private room if medically necessary
• all meals, including special, medically required diets
• regular nursing services
• special care units, such as coronary care
• drugs, medical supplies, treatments, and appliances provided by the facility, such as casts, splints, and wheelchairs, and
• rehabilitation services, such as physical therapy, occupational therapy, and speech pathology, provided while you are in the nursing facility.

The costs for staying in a skilled nursing facility for the first twenty days are covered 100%; after that, there is a co-pay (see below).

What Will Medicare Not Cover in an SNF?

Medicare coverage for a skilled nursing facility does not include:

• personal convenience items such as television, radio, or telephone
• private duty nurses, or
• a private room when not medically necessary.

How Much Will Medicare Part A Pay for a Skilled Nursing Facility?

Despite the common misconception that nursing homes are covered by Medicare, the truth is that Medicare covers only a limited amount of inpatient skilled nursing care. For each spell of illness, Medicare will cover only a total of 100 days of inpatient care in a skilled nursing facility, and then only if your doctor continues to prescribe daily skilled nursing care or therapy.

For the first 20 of 100 days, Medicare will pay for all covered costs, which include all basic services but not television, telephone, or private room charges.

For the next 80 days, the patient is personally responsible for a daily copayment, and Medicare pays the rest of the covered costs. In 2023, the copayment amount is $200 per day; the amount goes up each year.

How Long Will Medicare Pay for an SNF?

After 100 days in any benefit period, you are on your own as far as Medicare Part A hospital insurance is concerned. Medicare will pay nothing after 100 days. (Lifetime reserve days, available for hospital coverage, don't apply to a stay in a nursing facility.)

But if you later begin a new spell of illness (called a benefit period), your first 100 days in a skilled nursing facility will again be covered. For more information on benefit periods and lifetime reserve days, see our article on Medicare Part A coverage.

_{Updated October 7, 2022}