Medicare Skilled Nursing Facility Coverage: What It Covers and What It Does Not

Medicare Part A covers short-term skilled nursing facility (SNF) care -- but the rules are frequently misunderstood, and many beneficiaries are surprised to discover what is and is not covered. Here is a clear, complete guide to Medicare SNF benefits.

Medicare SNF coverage is designed for short-term rehabilitation and skilled care following a hospitalization -- not long-term custodial care. The distinction is critical:

Covered (skilled care):

• Physical, occupational, or speech therapy after surgery, stroke, or injury
• Skilled nursing care (wound care, IV antibiotics, tube feeding, complex medication management)
• Monitoring of complex medical conditions requiring professional nursing judgment

NOT covered (custodial care):

• Help with daily activities (bathing, dressing, eating, toileting) when no skilled care is needed
• Long-term nursing home care
• Maintenance therapy (therapy to maintain current function, not improve it)

To qualify for Medicare SNF coverage, you must have a qualifying inpatient hospital stay of at least 3 consecutive days (not counting the day of discharge).

Critical distinction -- inpatient vs. observation status:

• Inpatient admission: Counts toward the 3-day requirement
• Observation status: Does NOT count toward the 3-day requirement

Many patients are placed under observation status rather than formally admitted -- and may not realize it. If you are in the hospital for several days but under observation status, you do not qualify for Medicare SNF coverage.

Action: Always ask your hospital care team whether you are admitted as an inpatient or under observation status. If you are under observation and need SNF care, ask your doctor to change your status to inpatient if clinically appropriate.

Medicare SNF coverage is organized by day within a benefit period:

Medigap Plan G covers the $217/day coinsurance for days 21-100 -- making SNF care effectively free for Plan G enrollees through day 100.

Medicare SNF coverage is measured in benefit periods, not calendar years. A benefit period begins the day you are admitted to a hospital or SNF and ends when you have been out of a hospital or SNF for 60 consecutive days.

Implication: If you are discharged from a SNF, recover at home for 60 days, and then need SNF care again, a new benefit period begins -- and you get another 100 days of potential SNF coverage.

Medicare only covers SNF days when you are receiving skilled care. If your condition stabilizes and you no longer need skilled nursing or therapy, Medicare coverage ends -- even if you are still in the SNF.

Your rights: If Medicare coverage ends while you are in a SNF, the facility must give you a written notice (Notice of Medicare Non-Coverage). You have the right to appeal this decision and request a review by a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).

After 100 days, Medicare pays nothing for SNF care. Options for continued care include:

• Medicaid (for qualifying low-income beneficiaries)
• Long-term care insurance
• Private pay

Planning for potential long-term care costs is essential -- Medicare's SNF benefit is a bridge, not a long-term solution.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.