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Medicare Skilled Nursing Facility Coverage Limits Explained
Quick Summary
Medicare covers up to 100 days of skilled nursing facility coverage per benefit period, but only after a qualifying inpatient hospital stay of at least three consecutive days. Days 1 through 20 are fully covered, days 21 through 100 carry a daily coinsurance, and Medicare pays nothing from day 101 onward.
- Most people need at least three consecutive days as an inpatient before SNF care is covered.
- Days 1 through 20 of a benefit period are covered in full, with no daily cost to you.
- Days 21 through 100 require a daily coinsurance, which changes every January 1.
- A benefit period resets only after 60 consecutive days without inpatient hospital or SNF care.
- File a fast appeal with your Quality Improvement Organization before the coverage end date on your notice.
Table of Contents
- How Medicare Skilled Nursing Facility Coverage Works
- Medicare SNF Coverage Requirements You Must Meet
- Medicare Skilled Nursing Facility Days: The 100-Day Limit
- Medicare SNF Coinsurance and Daily Costs
- When Medicare SNF Days Reset and New Benefit Periods Begin
- Appealing a Coverage Denial or Early Discharge
- Planning Your Next Step Once Medicare SNF Coverage Ends
- Frequently Asked Questions
How Medicare Skilled Nursing Facility Coverage Works
Last Updated: November 7, 2026
Medicare covers skilled nursing facility (SNF) care, but only under tight conditions. Most people assume Medicare pays for long stays in a nursing home. It does not.
This guide explains how Medicare skilled nursing facility coverage limits work.
Medicare skilled nursing facility coverage is short-term rehabilitation or skilled care. It is not custodial care for daily living needs like bathing or dressing alone.
- Skilled care: Services that need a licensed nurse or therapist, such as physical therapy or wound care.
- Custodial care: Help with everyday tasks. Medicare generally does not pay for this in a SNF.
- Benefit period: The window that starts when you enter a hospital and ends after you go 60 days without skilled care.
A common mistake is assuming a doctor's order alone guarantees coverage. Medicare also checks medical necessity and the other rules below.
Medicare SNF Coverage Requirements You Must Meet
To get Medicare SNF coverage, you generally need three things: a qualifying inpatient hospital stay, a need for daily skilled care, and admission to a Medicare-certified facility within a set time after discharge.
The Qualifying Inpatient Hospital Stay
Most people must have been an inpatient for at least three consecutive days before the SNF stay. The clock usually starts on the day you are formally admitted as an inpatient, not the day you arrived at the emergency room. Days you spend in the ER or in observation do not count toward this requirement.
Watch out: A doctor may order a stay as observation even when you feel like you were "in the hospital" for days. Ask for your status in writing.
Inpatient Status Versus Observation Status
Inpatient status means a doctor formally admitted you to the hospital. Observation status means the hospital is watching you to decide whether to admit you. You can stay in a hospital bed under either status, but only inpatient days count toward SNF eligibility.
Check your status during your stay. The hospital must give you a Medicare Outpatient Observation Notice (MOON) if you are under observation for more than 24 hours. Use it to confirm which days count.
Medicare Skilled Nursing Facility Days: The 100-Day Limit
Medicare pays for up to 100 days of SNF care in each benefit period (SNF Care Coverage). The first 20 days are fully covered. Starting on day 21, you pay a daily coinsurance amount.
Covered Days 1-20 Versus Days 21-100
- Days 1-20: Medicare covers the full cost of approved skilled care after the deductible has been met under Part A. You pay nothing per day.
- Days 21-100: You pay a daily coinsurance. Medicare covers the rest.
- Day 101 and beyond: Medicare does not pay. You pay all costs yourself, or you use other coverage.
These days are per benefit period, not per calendar year. A new benefit period starts only after 60 days in a row with no inpatient hospital or SNF care.
Medicare SNF Coinsurance and Daily Costs
Medicare sets the SNF daily coinsurance amount each year, and it changes every January 1 (SNF Care Coverage). Confirm the current-year figure at Medicare.gov or in your "Medicare & You" handbook before you budget, because the amount you owe on day 21 depends on the year your stay falls in.
The key distinction that trips people up is the difference between the Medicare-approved amount and the facility's billed rate. Medicare pays its share based on the approved amount for covered skilled services.
Here is how the cost sharing breaks down across a single benefit period:
- Days 1-20: You pay $0 per day for covered skilled care. Medicare pays the approved amount. (You still owe the Part A inpatient deductible for the hospital stay that qualified you.)
- Days 21-100: You pay the daily coinsurance amount set for that year; Medicare pays the balance of the approved amount.
- Day 101 and beyond: Medicare pays nothing. You pay the facility's full daily rate, or another payer (Medicaid, long-term care insurance, or private funds) does.
A Worked Example
Suppose you are admitted to a SNF after a qualifying inpatient stay and Medicare approves 100 days. Use the current-year daily coinsurance figure published at Medicare.gov in place of a specific amount:
- Days 1-20: 20 days × $0 = $0 out of pocket for SNF coinsurance.
- Days 21-100: 80 days × the daily coinsurance = your coinsurance total. Multiply the published daily amount by 80 to get your exposure for the back half of the benefit period.
- Day 101 onward: each additional day costs the facility's private-pay rate, which you should confirm in writing.
That 80-day multiplier is the number most people miss. The coinsurance is small per day but compounds across the 80 coinsured days, so a stay that runs the full 100 days carries a meaningful out-of-pocket total even before any non-covered services.
Watch out: Your bill can exceed the coinsurance alone if your stay includes services Medicare does not cover, private-duty nursing, a private room when not medically necessary, or custodial help with bathing and dressing. Review the itemized statement, not just the daily rate.
Where Supplemental Coverage Fits
If you have Medigap, check whether your plan covers the SNF coinsurance for days 21-100; some plans do and some do not, and the answer varies by letter plan. If you are in a Medicare Advantage plan, the plan sets its own SNF cost sharing and may use a different day structure, so read the plan's Evidence of Coverage rather than assuming Original Medicare rules apply.
The table below summarises how cost sharing changes across a single SNF benefit period.
| Days | What you pay | Who pays the rest |
|---|---|---|
| 1-20 | $0 per day for covered skilled care | Medicare |
| 21-100 | Daily coinsurance set for that year | Medicare |
| 101 and beyond | Facility's full daily rate | Not Medicare; you or another payer |
When Medicare SNF Days Reset and New Benefit Periods Begin
The 100-day limit is per benefit period, not per calendar year, and a benefit period does not start on January 1. It starts when you are admitted as an inpatient to a hospital or enter a SNF, and it ends only after you have gone 60 consecutive days without inpatient hospital care or skilled nursing facility care. Cross that 60-day threshold and your next admission opens a fresh benefit period with a new 100 days.
What Counts Toward the 60-Day Break
The clock measures days without inpatient hospital or SNF care. A few practical points matter:
- Time at home, in assisted living, or receiving home health care generally does not interrupt the 60-day count, because those are not inpatient hospital or SNF days.
- A return to the hospital as an inpatient, or readmission to a SNF, resets the count to zero and keeps you in the same benefit period if you have not yet cleared 60 days.
- Outpatient observation in a hospital is not inpatient care, so confirm your status if you are unsure whether a hospital visit affected your clock.
Three Timelines That Show How It Works
Timeline 1, Discharge and readmission inside 60 days. You finish a SNF stay on March 1 after using 30 days. You are readmitted to a SNF on April 15, which is 45 days later.
Timeline 2, A clean break past 60 days. You leave a SNF on March 1. You have no inpatient hospital or SNF care through April 30, which is 60 days.
Timeline 3, A new calendar year mid-stay. Your benefit period began in November and you are still receiving care in January.
How to Confirm Which Benefit Period You Are In
Before a new admission, ask the facility's business office and your Medicare plan two questions: when did my current benefit period begin, and how many SNF days have I already used in it? You can also review your Medicare Summary Notice or plan explanation of benefits, which lists dates of service. If the answers conflict, request a written breakdown and keep it with your records.
Watch out: People often assume a new year restores their 100 days, or that a short hospital readmission starts a fresh benefit period. Neither is true unless 60 consecutive days have passed without inpatient hospital or SNF care. Confirm the dates before you plan around a reset.
Appealing a Coverage Denial or Early Discharge
Facilities must give you a Notice of Medicare Non-Coverage (NOMNC) before Medicare coverage ends (Your Protections). You have the right to appeal the decision.
Follow these steps:
- Read the NOMNC and note the end date of coverage.
- Request a fast appeal with your Quality Improvement Organization (QIO) before the coverage end date shown on the notice. Our guide to steps to appeal a Medicare decision walks through each stage of the process.
- Ask the facility for your medical records and care plan.
- Keep a written log of every call and letter.
Many people try to appeal too late. Act quickly, and check the deadline printed on your notice.
Planning Your Next Step Once Medicare SNF Coverage Ends
When Medicare SNF coverage ends, you have several options. You can go home with home health care, move to a long-term care setting, or use Medicaid if you qualify.
Options to review:
- Home health care: Medicare may cover part-time skilled nursing or therapy at home.
- Medicare Advantage plan: Some plans cover SNF stays differently and may have their own limits. Compare plans carefully before you enroll.
- Supplemental insurance: Some Medigap plans help pay coinsurance for days 21-100 of SNF care.
- Private payment: You pay the daily rate yourself if you need care beyond covered days.
Plan early. Talk with a licensed agent or your state health insurance counseling program to match coverage to your situation.
Medicare skilled nursing facility coverage limits depend on your hospital status, your care needs, and your plan. For help reviewing your options, contact Your Medicare Agent Medicarehelpinfl for a clear, no-pressure review.
Frequently Asked Questions
How long can a person stay in a skilled nursing facility under Medicare?
Original Medicare Part A covers up to 100 days in a skilled nursing facility per benefit period. Days 1 through 20 are fully covered with no coinsurance. Starting on day 21, you pay a daily coinsurance amount, which is set each year by CMS, so check Medicare.gov or call 1-800-MEDICARE for the current figure. Coverage ends after day 100 even if you still need care. Your Medicare Agent can help you review your benefits before a stay begins.
Do Medicare SNF days reset after a hospital stay?
Medicare SNF days reset only when a new benefit period begins. A benefit period starts the day you are admitted as an inpatient to a hospital or SNF and ends after you have been out of all hospitals and SNFs for 60 days in a row. If you return to a facility within that 60-day window, you generally continue the same benefit period and any days you have already used still count against the 100-day limit.
What are the Medicare SNF coverage requirements?
To qualify for Medicare SNF coverage, you generally need a qualifying inpatient hospital stay and must be admitted to a Medicare-certified SNF within the time frame set by Medicare, which you should confirm at Medicare.gov. You must also need daily skilled care, such as skilled nursing or rehabilitation services, that can only be provided on an inpatient basis, and a doctor must certify that care is medically necessary. Observation status does not count toward the three-day requirement.
Does Medicare cover long-term care in a nursing home?
Original Medicare generally does not cover long-term custodial care in a nursing home, which includes help with bathing, dressing, and other daily activities when no skilled care is needed. Medicare SNF coverage is for short-term skilled care after a qualifying hospital stay. For long-term custodial care, other options such as Medicaid, private payment, or long-term care insurance may apply. Check official sources or speak with a licensed agent about your options.
