Does Medicare Help with Skilled Nursing Facilities? A Comprehensive Guide

Oct 23, 2025 3 min read •

senior care Medicare Healthy Aging

According to the National Council on Aging, Medicare will generally not pay for long-term custodial care in a nursing home. But the question, does Medicare help with skilled nursing facilities, involves specific rules and criteria related to short-term, medically necessary care after a hospital stay.

Quick Summary

Medicare Part A offers limited, short-term coverage for skilled nursing facility (SNF) care following a qualifying inpatient hospital stay, but strict conditions apply, and it does not cover long-term custodial care. Coverage is typically capped at 100 days per benefit period and involves daily coinsurance after the initial 20 days.

Key Points

Limited, Short-Term Coverage: Medicare (Part A) covers short-term, medically necessary care in a skilled nursing facility for up to 100 days per benefit period, not long-term care.
Qualifying Hospital Stay: You must have a prior inpatient hospital stay of at least three consecutive days to qualify for SNF coverage.
Costs for a Benefit Period: The first 20 days are covered in full, but days 21–100 require a daily coinsurance payment. After 100 days, you are responsible for all costs.
Skilled vs. Custodial Care: Medicare covers skilled care (requiring professional medical staff) but does not cover custodial care (help with daily living activities).
Original vs. Advantage Plans: Medicare Advantage plans may offer different rules for SNF care, including possibly waiving the three-day hospital stay requirement, but may have network restrictions.
Consider Supplemental Insurance: Supplemental Medigap policies can help cover the coinsurance for days 21–100, while long-term care insurance or Medicaid are options for extended needs.

The Distinction: Skilled Care vs. Custodial Care

It is crucial to understand that Medicare's coverage depends entirely on the type of care required. Skilled nursing care is medically necessary and requires professional staff like registered nurses or physical therapists. Medicare Part A covers this under specific conditions.

Medicare does not cover custodial care, which involves non-medical assistance with daily living activities such as bathing, dressing, and eating. This is usually needed for an extended period.

Medicare Part A Coverage Requirements

To qualify for Medicare Part A coverage of a skilled nursing facility (SNF) stay, you must meet several key criteria:

Qualifying Hospital Stay: An inpatient hospital stay of at least three consecutive days is required, not including the discharge day or time under observation.
Timely Admission to SNF: Admission to a Medicare-certified SNF must be within 30 days of leaving the hospital for the same or a related medical condition.
Daily Skilled Care Need: A doctor must certify the need for daily skilled nursing or rehabilitation services for the condition treated during the hospital stay.
Medicare-Certified Facility: Care must be provided in a Medicare-certified SNF.

The Benefit Period Explained

Medicare uses 'benefit periods' to measure SNF service use. A benefit period starts when you are admitted as an inpatient in a hospital or SNF and ends after 60 consecutive days without receiving inpatient hospital or skilled SNF care. A new benefit period begins with a readmission after a 60-day break and another qualifying hospital stay.

What Does Medicare Part A Pay?

For each benefit period, your 2025 out-of-pocket costs for a Medicare-covered SNF stay are:

Days 1–20: $0. Medicare covers the full cost.
Days 21–100: Daily coinsurance of $209.50 (2025).
Days 101 and beyond: You pay all costs.

Comparing Coverage: Original Medicare vs. Medicare Advantage

Understanding how different Medicare plans handle SNF benefits is important.


Feature	Original Medicare (Part A)	Medicare Advantage (Part C)
Qualifying Hospital Stay	Requires a three-day inpatient hospital stay.	Some plans may waive the three-day hospital stay rule.
Network Restrictions	Can use any Medicare-certified SNF if a bed is available.	May have a network of preferred SNFs; costs may be lower in-network.
Coinsurance Costs	Standard coinsurance for days 21–100 ($209.50 in 2025).	Varies by plan.
Care Management	Managed directly by Medicare.	Managed by a private insurance company; prior authorization may be needed.
Flexibility	Generally more flexible in facility choice.	May have network and pre-authorization requirements.

What if Medicare Coverage Ends?

Since Medicare SNF coverage is temporary, plan for alternatives. Once Medicare coverage ends, you are responsible for the full cost.

Long-Term Care Insurance: Covers custodial and extended skilled care, but can be expensive with underwriting.
Medigap Policies: Many cover the coinsurance for days 21–100, reducing short-term costs.
Medicaid: A program covering long-term care for eligible individuals with limited income and resources. Eligibility varies by state.
Personal Funds: Use savings, investments, or a reverse mortgage.

Steps to Secure Medicare-Covered SNF Care

If you anticipate needing skilled care after a hospital stay:

Confirm Inpatient Status: Verify a formal inpatient admission of at least three consecutive days with hospital staff.
Talk to Discharge Planner: Utilize the hospital's discharge planner to identify Medicare-certified SNFs and arrange transfer.
Ensure Timely Transfer: Arrange SNF admission within 30 days of hospital discharge.
Know Benefit Period Status: Track SNF days and watch for notices of Medicare coverage ending.
Be Prepared to Appeal: If coverage ends but you still need daily skilled care, you have the right to a fast appeal.

Note: For official information, consult the Skilled Nursing Facility Care page on the official Medicare website.

Conclusion

Medicare can cover short-term, medically necessary skilled nursing care but not long-term care. Understanding the strict conditions, benefit periods, and the difference between skilled and custodial care is vital for planning and securing appropriate care.

Frequently Asked Questions

A skilled nursing facility (SNF) provides short-term, medically necessary skilled care, such as rehabilitation or wound care. A nursing home can provide both short-term skilled care and long-term custodial care, but Medicare will not cover the long-term portion.

No, Medicare coverage for a skilled nursing facility is limited. For each benefit period, Medicare covers the full cost for the first 20 days, and requires a daily coinsurance for days 21 through 100. After 100 days, you are responsible for all costs.

A qualifying hospital stay is an inpatient hospital admission of at least three consecutive days. The day of discharge and time spent in the emergency room or under observation do not count toward this requirement.

A benefit period begins the day you are admitted to a hospital or skilled nursing facility and ends after you have not received inpatient care for 60 consecutive days. If you are admitted again after 60 days, a new benefit period may start.

Not necessarily. While they must cover at least the same level of benefits as Original Medicare, their rules for skilled nursing facility coverage, such as network requirements or prior authorization, can differ. Some plans may waive the three-day hospital stay rule.

Medicare does not cover long-term custodial care. For long-term needs, you would typically need to explore other options such as personal funds, Medicaid, or a long-term care insurance policy.

Yes, many Medigap (Medicare Supplement) plans cover the daily coinsurance for days 21–100 in a skilled nursing facility, which can significantly reduce your out-of-pocket costs for a short-term stay.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.