Does Medicare cover rehab in a skilled nursing facility?

What does Medicare cover in a skilled nursing facility?

Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. Medicare-covered services in a skilled nursing facility include, but aren't limited to:

• A semi-private room (a room you share with other patients) and meals.
• Skilled nursing care.
• Physical therapy, occupational therapy and speech-language pathology services, if they're needed to meet your health goal.
• Medical social services and dietary counseling.
• Medications, and medical supplies and equipment used in the facility.
• Ambulance transportation, when other transportation endangers your health, to the nearest supplier of needed services that aren't available at the SNF.

Who qualifies for Medicare skilled nursing facility coverage?

You must meet all of these conditions:

• You have Part A and have days left in your benefit period to use.
• You have a qualifying inpatient hospital stay: a medically necessary inpatient stay of at least 3 days in a row, starting the day you were admitted as an inpatient and not counting the day you leave the hospital.
• You enter the SNF within a short time (generally 30 days) of leaving the hospital.
• Your doctor or other health care provider has decided you need daily skilled care, like intravenous fluids or medications or physical therapy, given by or under the supervision of skilled nursing or therapy staff.
• You get these skilled services in a Medicare-certified SNF.
• You need skilled services for a condition that was also treated during your hospital stay (even if it wasn't the reason you were admitted), or for a new condition that started while you were getting SNF care for that condition.
• You need skilled nursing care or therapy to improve or maintain your current condition, or to prevent or delay it from getting worse.

Does time under observation count toward the 3-day hospital stay?

No. Time you spend in the hospital under observation or in the emergency room before you're admitted doesn't count toward the 3-day qualifying inpatient hospital stay, even if you're there overnight, because while you get observation services you're considered an outpatient. For example, if you spend one day getting observation services and are then formally admitted as an inpatient for 2 more days, Medicare doesn't cover your SNF stay. See how Medicare covers observation stays.

You may not need a 3-day inpatient stay if your doctor participates in an Accountable Care Organization (ACO) approved for a Skilled Nursing Facility 3-Day Rule Waiver, so always ask your doctor or hospital staff whether Medicare will cover your SNF stay. If the hospital changed your status from inpatient to outpatient getting observation services, you may be able to appeal the denial of Part A inpatient coverage, for hospital stays back to January 2009.

What do I pay for skilled nursing facility care?

What you pay for each benefit period in 2026 depends on how long you're getting skilled nursing facility care. You don't have to pay the Part A deductible for SNF care if you already paid it for care you got in a hospital during the same benefit period.

• Days 1–20: $0 each day after you pay the $1,736 Part A deductible.
• Days 21–100: $217 each day.
• Days 101 and beyond: you pay all costs. Part A limits SNF coverage to 100 days in each benefit period.

What happens if I leave the skilled nursing facility or stop skilled care?

If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for more SNF care, though the new stay doesn't need to be for the same condition. If you re-enter the same or another SNF within 30 days, or start getting skilled care again within 30 days, you don't need another 3-day hospital stay. If your break in skilled care lasts at least 60 days in a row, your current benefit period ends and your SNF benefits renew, up to 100 days.

If you refuse your daily skilled care or therapy, you may lose your Medicare SNF coverage, though a condition that keeps you from getting skilled care, like the flu, may let you keep coverage temporarily. If you disagree with your discharge, you can appeal; see how to appeal a Medicare decision.

Does Medicare Advantage or Medigap change SNF coverage?

Medicare Advantage plans may waive the 3-day minimum inpatient hospital stay and may charge copayments during the first 20 days, so check with your plan. Medigap policies help pay your share of costs in Original Medicare, and Medigap plans can help pay the daily skilled nursing facility coinsurance; how much depends on the plan letter.

Skilled nursing facility care is different from long-term custodial care, like help with dressing, bathing and using the bathroom. Medicare and Medigap don't pay for long-term care, including care in a nursing home; see Medicare and nursing home care.