Does Medicare cover skilled nursing facility (SNF) care?

Three gates have to be open at the same time. First, you need a qualifying inpatient hospital stay of at least three consecutive days, not counting your discharge day. Second, the SNF admission has to happen within 30 calendar days of hospital discharge. Third, you have to need daily skilled care — skilled nursing 7 days a week or skilled therapy at least 5 days a week — that's related to the condition treated in the hospital.

If any one of those gates is closed, Medicare doesn't pay. The Part A SNF benefit caps at 100 days per benefit period, with full coverage for days 1–20 and a daily coinsurance for days 21–100.

This is the single most common SNF denial I see. Hospitals sometimes classify a patient as 'observation' instead of 'inpatient' — same bed, same care, totally different Medicare status. Observation nights don't count toward the 3-day rule, so even a 4- or 5-night observation stay can result in zero SNF coverage.

The MOON notice (Medicare Outpatient Observation Notice) is the document hospitals must give within 36 hours of an observation stay. If you got one, your stay was observation, not inpatient. Appeal options exist but the rules are tight — see the observation-status-trap page for next steps.

If your stay was observation, your SNF coverage rules are different. → See the observation-status trap

Days 1–20 are fully covered by Medicare. Starting day 21, you owe a daily coinsurance — $209.50/day at the 2025 rate (CMS announces the 2026 rate each fall). For a full coinsurance run from day 21 through day 100, that's roughly $16,760 out of pocket at the 2025 rate.

Medigap (Medicare Supplement) plans typically cover this coinsurance. If you have one, check your policy. If you don't, the day-21 cliff is real — plan for it.

On day 101, Medicare's SNF benefit ends for that benefit period. After that, the cost is yours — unless you qualify for Medicaid long-term care, which has its own asset and income tests and is administered state-by-state.

The benefit period resets after 60 consecutive days with no inpatient or SNF care. So a future hospitalization plus another qualifying SNF stay could open a new 100-day window. But families running out of days now usually need to start the Medicaid LTC conversation immediately — the application can take months.

If you're heading toward day 100, start looking at Medicaid now. → Medicaid nursing home coverage

Help with bathing, dressing, eating, and other activities of daily living — the technical term is 'custodial care' — isn't covered by Medicare's SNF benefit on its own. Medicare requires daily skilled need: skilled nursing 7 days/week, or skilled therapy at least 5 days/week.

If the only need is custodial, look at Medicaid LTC, long-term-care insurance if you have a policy, or in some cases home and community-based services waivers (HCBS) through Medicaid that may cover home aides instead of facility care.

Medicare Advantage plans are required by law to cover at least the same benefits as Original Medicare — including the SNF benefit. But cost-sharing and prior-authorization rules can vary by plan. Some MA plans waive the 3-day inpatient rule. Some require prior authorization before you transfer to a SNF. Some have different daily copays than the Original Medicare coinsurance.

Check your plan's Evidence of Coverage document or call the plan directly. The Original Medicare rules above are your floor; your specific MA plan may have additional features.

Helping a parent or spouse navigate this is one of the most useful things you can do. The gates are the same whether they or you are the patient — qualifying inpatient stay, daily skilled need, certified facility — but you can be the person who catches an observation-status problem before it becomes a denied claim.

What you'll need: their Medicare number (red, white, and blue card), the hospital's discharge paperwork, the MOON notice if observation, and the SNF's Medicare certification status. If they want you to talk to Medicare on their behalf, they'll need to authorize it via Form CMS-10106 (Authorization to Disclose Personal Health Information).

If you're helping someone else, here's what to bring. → Get help for someone else

SNF coverage questions get specific fast — swing-bed hospitals, ESRD patients, hospice election interactions, dual-eligible Medicare-Medicaid scenarios, appeals after a denial. If your situation doesn't fit cleanly into the cards above, the right next step is usually a 15-minute call with someone who's seen the specific edge case before.

SHIP (State Health Insurance Assistance Program) at 1-877-839-2675 is free, federally funded, and unbiased — they help with coverage questions, appeals, and understanding your specific Medicare picture. The Chapter card on this page is another route: licensed Medicare advisors who help families read the rules.