Medicare Skilled Nursing Facility Coverage: The 100-Day Rule Explained

How Medicare Part A Covers Skilled Nursing Facility Care

Medicare Part A pays for short-term, medically necessary care in a Medicare-certified skilled nursing facility after a qualifying hospital stay. The benefit is designed for rehabilitation and recovery, not for indefinite nursing home living.

In 2026, Original Medicare covers eligible SNF care for up to 100 days per benefit period. A "benefit period" starts the day you're admitted as an inpatient and ends after you've been out of a hospital or SNF for 60 consecutive days. If you're readmitted after that 60-day break, a new benefit period (and a new 100-day SNF clock) starts. For a broader look at how these pieces work, see our overview of Medicare Part A and Part B coverage.

To qualify for coverage, three things generally need to be true:

• You had a qualifying inpatient hospital stay of at least 3 consecutive days.
• You enter the SNF within 30 days of leaving the hospital.
• A doctor certifies you need daily skilled nursing or therapy for a condition treated during that hospital stay.

The 3-Day Inpatient Rule and the Observation Trap

The 3-day rule is where many families get burned. Medicare requires a medically necessary inpatient hospital stay of at least 3 consecutive calendar days before it will cover SNF care. You count the day you were admitted as an inpatient, but you do not count the day you're discharged.

Critically, time you spend in the emergency department or under outpatient observation status does not count toward the 3 days, even if you slept in a hospital bed for those nights. That's the "observation trap": a patient can be in the hospital for four or five nights, get transferred to a rehab facility, and then discover Medicare will pay nothing because the hospital stay was billed as observation rather than inpatient.

What Medicare SNF Coverage Costs in 2026

Once you meet the 3-day rule and enter a certified SNF, Medicare's daily cost sharing follows a fixed schedule that resets with each benefit period.

Days 1 through 20 are fully covered by Part A. Beginning on day 21, you owe a daily coinsurance of $217 in 2026, up from $209.50 in 2025. If you use the full 80 days of coinsurance, you'd pay $17,360 out of pocket for that one benefit period. After day 100, Medicare pays nothing and you're responsible for the entire bill until a new benefit period begins.

Note that the Part A hospital deductible is $1,736 per benefit period in 2026, and Medicare set the SNF coinsurance at one-eighth of that amount. If you already paid the Part A deductible during the hospital stay that qualified you for SNF care, you do not pay it again when you enter the SNF.

Skilled Care vs. Custodial Care: The Line Medicare Draws

This is the most important distinction in the entire SNF benefit. Medicare pays for skilled care, not custodial care, and understanding the difference explains why so many long-term nursing home stays are not covered.

What counts as skilled care

Skilled care is medically necessary care that must be performed or supervised by licensed professionals (registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech therapists) and is ordered by a doctor. Examples include:

• IV medications and injections
• Complex wound care and dressing changes
• Post-surgical rehabilitation therapy
• Tube feeding management
• Monitoring an unstable medical condition

What counts as custodial care

Custodial care is non-medical help with everyday activities of daily living (ADLs). It can safely be provided by non-licensed caregivers or family members. Examples include help with:

• Bathing and dressing
• Eating and toileting
• Transferring in and out of bed
• Walking and moving around
• Supervision for memory loss or safety

The same skilled-versus-custodial line shows up in Medicare home health care coverage: Medicare pays for skilled nursing and therapy at home, but not for round-the-clock personal care.

Why Medicare Doesn't Cover Long-Term Nursing Home Care (and Where Medicaid Steps In)

Once a patient stops needing daily licensed medical care and only needs help with bathing, dressing, or memory supervision, Medicare stops paying, even if they're still in the same facility. That's because long-term nursing home care is treated as custodial, not skilled. Medigap policies follow Medicare's lead and also don't cover long-term custodial care, which is one of the biggest gaps in Original Medicare that catches families off guard.

That leaves families with three main options to pay for long-term care:

1. Private pay from savings, home equity, or family contributions
2. Long-term care insurance (if the policy was purchased before it was needed)
3. Medicaid, which pays for long-term custodial nursing home care indefinitely for people who meet strict financial and medical eligibility rules

Medicaid is the primary payer for long-term nursing home care in the United States. Unlike Medicare, Medicaid can cover both skilled and non-medical, long-term custodial care for as long as the person remains eligible. In most states in 2026, a single applicant needs monthly income at or below about $2,982 and countable assets at or below $2,000 to qualify for nursing home Medicaid, though residents typically must contribute nearly all of their monthly income toward the cost of care. Spousal impoverishment rules protect a portion of assets and income for a spouse who still lives at home.

The Medicare Advantage 3-Day Rule Waiver

If you're enrolled in a Medicare Advantage (Part C) plan instead of Original Medicare, the 3-day inpatient rule may not apply to you. Many Medicare Advantage plans waive the 3-day hospital stay requirement and allow direct admission to a network SNF when medically necessary.

That flexibility comes with trade-offs, though. MA plans usually require:

• Prior authorization before the SNF stay
• In-network SNFs only
• Ongoing utilization review during the stay, which can lead to earlier discharge decisions

There are also two federal waiver pathways worth knowing about. Certain Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program can waive the 3-day rule for assigned beneficiaries who use a partner SNF. And starting January 1, 2026, CMS's new Transforming Episode Accountability Model (TEAM) waives the SNF 3-day rule for Original Medicare beneficiaries at participating hospitals who have one of five specific surgical procedures (including lower-extremity joint replacement and surgical hip femur fracture repair), as long as they're transferred to a CMS-qualified SNF within 30 days. TEAM will run through 2030 at roughly 740 hospitals nationwide, and the qualifying SNF must be rated 3 stars or better on Nursing Home Compare for at least 7 of the previous 12 months.

If you're weighing Original Medicare plus a supplement against an MA plan for SNF coverage specifically, our full Medigap vs. Medicare Advantage comparison breaks down the trade-offs in detail.

How to Appeal an Early SNF Discharge

Being told your Medicare-covered SNF stay is ending before you feel ready is one of the most common and stressful moments in the whole benefit. You have the right to a fast appeal, and the process is designed to work in your favor if you act quickly.

Here's how it works:

1. Get the notice. The SNF must give you a written Notice of Medicare Non-Coverage (NOMNC) at least 2 days before your covered services end.
2. Contact the BFCC-QIO. Call the Beneficiary and Family Centered Care-Quality Improvement Organization listed on your notice. The deadline is generally no later than noon the day before your coverage is set to end.
3. Review the DENC. Once you file, the SNF must issue a Detailed Explanation of Non-Coverage explaining why they think coverage should end.
4. Submit evidence. You can send the QIO your own information: doctor's notes, therapy progress, examples of skilled needs, and any reasons discharge is unsafe.
5. Wait for the decision. The QIO typically decides by the close of business the day after it receives the information it needs. While the appeal is pending, you generally do not pay for the disputed care if you lose the initial appeal.

Where Medigap Fits Into the SNF Picture

For people on Original Medicare, a Medigap policy is what turns the 100-day SNF benefit from "partial coverage" into something closer to comprehensive coverage. The single biggest cost, the $217-per-day coinsurance from days 21-100, is exactly what most Medigap plans are built to cover.

Keep in mind that Medigap only helps with the coinsurance for Medicare-covered SNF days. If your stay converts to custodial care or extends past day 100, Medigap stops paying just like Medicare does. For most people, though, avoiding a $17,360 coinsurance bill on a single rehab stay is more than enough reason to pair Original Medicare with a comprehensive supplement. The two most popular choices are Medicare Supplement Plan G, which averages about $166 per month at age 65 in 2026, and Medicare Supplement Plan N, which runs closer to $123 per month at 65 with small office and ER copays.

Frequently Asked Questions

How many days will Medicare pay for rehab in a skilled nursing facility?

Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period, but only days 1-20 are fully paid. Days 21-100 require a daily coinsurance of $217 in 2026, and Medicare pays nothing after day 100. A new benefit period (and a new 100-day allowance) can start after you've been out of a hospital or SNF for 60 straight days.

Does Medicare cover a nursing home if I need help with bathing and dressing?

No. Help with bathing, dressing, eating, and other activities of daily living is considered custodial care, and Medicare does not pay for custodial care when that's the only care you need. Medicaid is the main program that pays for long-term custodial nursing home care, but in most states in 2026 a single applicant needs monthly income under about $2,982 and countable assets under $2,000 to qualify. Long-term care insurance and private pay are the other common options.

What happens if my hospital stay was under observation instead of inpatient?

If you were classified as an outpatient under observation status, those days do not count toward Medicare's 3-day inpatient requirement, even if you slept in a hospital bed. That means Medicare will not cover a SNF stay that follows, and you could be billed for the entire cost of rehab. Always confirm your status in writing during the hospital stay, and ask for the Medicare Outpatient Observation Notice if you're under observation more than 24 hours.

Do all Medicare Advantage plans waive the 3-day hospital stay rule?

No. Some Medicare Advantage plans waive the 3-day rule and allow direct SNF admission, but many still require prior authorization and use of in-network facilities. The only way to know for sure is to check the plan's Evidence of Coverage or call the plan directly and ask whether the 3-day rule is waived, whether prior authorization is required, and which SNFs are in network.

Which Medigap plan is best for skilled nursing facility coverage?

Plans C, D, F, G, M, and N all cover 100% of the SNF coinsurance for days 21-100. For most people newly eligible for Medicare, Plan G offers the strongest combination of SNF coverage plus other Part A and Part B benefits, since Plans C and F are no longer available to people who became eligible for Medicare on or after January 1, 2020. Plan N is a lower-premium alternative that still covers SNF coinsurance in full, with small copays on office and ER visits.