Medicare Basics

• Medicare Part A (hospital insurance): Covers short-term, medically necessary skilled nursing facility (SNF) care if you meet specific requirements. Many people assume Medicare will cover a stay in a SNF indefinitely, but coverage is limited and tied strictly to skilled medical needs.

• Medicare does not cover long-term or custodial care.

• Maximum 100 days per benefit period:

o New benefit period: starts when out of any hospital or SNF for 60 consecutive days & then have a new 3+ days hospital stay (resetting the 100-day SNF allotment and the deductible).

• Coinsurance pay: Patient pays increasing coinsurance after day 20.

• Understanding rules is key to avoiding unexpected bills: for older adults, people with disabilities, and family caregivers

What Is Skilled Nursing Facility (SNF) Care?

• Short-term, medically necessary care provided in a licensed facility following a hospital stay.

• Offers a higher level of care than custodial nursing homes or assisted living communities.

• Care must be provided by, or under supervision of, licensed medical professionals such as registered nurses (RNs) or physical therapists.

Common reasons someone might need SNF care include:

• Recovery after surgery

• Rehabilitation following a stroke or serious illness

• Wound care or IV therapy

• Physical, occupational, or speech therapy

• Monitoring and treatment of complex medical conditions

• SNF care is designed to help individuals recover and regain function so they can safely return home or to a lower level of care.

Medicare Part A may help pay for SNF on short-term basis if:

• Qualifying inpatient hospital stay: Inpatient for at least 3 consecutive days, not counting the day of discharge. Time spent in the hospital under “observation status” does not count toward this requirement.

• Admission to the SNF shortly after hospital discharge (usually must begin within 30 days of leaving the hospital).

• Medical need for skilled care. The care must be medically necessary and require skilled services, such as daily nursing care or rehabilitation therapy that can only be provided by trained professionals.

• Medicare-certified skilled nursing facility.

Services Medicare A cover in a SNF (generally) includes:

• A semi-private room

• Meals

• Skilled nursing services

• Physical, occupational, and speech therapy

• Medical supplies and equipment used during care

• Qualifying medications related to the SNF stay

• Ambulance transportation to the nearest provider of necessary services if other modes of transportation would pose a health risk

Medicare A does Not Cover SNF Care when:

• Long-term or custodial care, such as help with bathing, dressing, or eating when no skilled medical care is required

• Stays not following a qualifying 3-day inpatient hospital admission

• Facilities that are not Medicare-certified

• Continued SNF care once no longer needs skilled services

Cost of SNF Care Cost Under Medicare:

• Medicare-covered SNF care is limited to up to 100 days per benefit period, and costs depend on how long a person stays.

• Days 1 to 20: Medicare Part A pays the full approved cost.

• Days 21 to 100: Part A covers part of the cost.

o Patient pays a coinsurance: $217/day in 2026.

• Days 100+: Patient pays all the costs of their SNF care.

• Medigap (Medicare Supplement) some plans may cover some or all the daily coinsurance for days 21 to 100.

Why Understanding SNF Coverage Matters:

• Confusion can lead to financial strain and difficult decisions during an already stressful time.

• Many people assume Medicare will cover a stay in a skilled nursing facility indefinitely, when in reality, coverage is limited and tied strictly to skilled medical needs.