Caregiver Support14 mins
Skilled nursing guide
Skilled nursing, and Medicare's 100 days.
After a hospital stay, Medicare can pay for short-term skilled nursing and rehab. Here is how that differs from long-term nursing home care, what Medicare covers day by day, how to protect your coverage before discharge and how to judge a facility for a rehab stay.
- days of skilled nursing Medicare can cover per benefit period
- 100
- a day for days 1 to 20, once the Part A deductible is met
- $0
- a day for days 21 to 100 in 2026
- $217
- days in a row as a hospital inpatient needed first
- 3
Traditional Medicare, 2026 amounts from Medicare.gov. Medicare Advantage plans set their own rules.
01The difference
Skilled nursing facility vs. nursing home
Usually the same building, with a different kind of stay. What differs is the care you need, how long you stay and who pays.
| Skilled nursing (SNF) care | Long-term nursing home care | |
|---|---|---|
| Purpose | Recovery and rehab after a hospital stay | Daily help and nursing care for people who can no longer live safely at home |
| Typical length | Days to weeks; Medicare covers up to 100 days per benefit period | Months to years |
| Care | Skilled nursing and therapy: wound care, IV medicines, physical, occupational and speech therapy | Help with bathing, dressing, eating and medicines, with nursing oversight |
| Who pays | Medicare Part A for people who qualify, Medicare Advantage plans, other insurance | Medicaid for people who qualify, long-term care insurance or savings; Medicare does not pay for custodial care |
| Where | Usually a nursing home certified by Medicare as a skilled nursing facility | Usually the same nursing home, certified by Medicaid as a nursing facility |
02Coverage
What Medicare pays: the 100-day rule
Traditional Medicare Part A pays for skilled nursing only after a qualifying hospital stay, and only while you need daily skilled care. These are the 2026 amounts.
- Days 1–20
$0 a day
After the Part A deductible ($1,736 in 2026), which is usually already paid for the hospital stay in the same benefit period.
- Days 21–100
$217 a day
You pay a daily coinsurance; Medicare pays the rest. Some supplemental plans pay it for you.
- Day 101 on
Medicare stops paying
You pay the full cost, unless Medicaid, long-term care insurance or another plan covers it.
Who qualifies
- A qualifying hospital stay. At least 3 days in a row as an admitted inpatient, counting the day you were admitted but not the day you left. Observation and emergency room time before admission don’t count.
- A prompt move. You enter the skilled nursing facility within 30 days of leaving the hospital, or later if skilled care wasn’t medically appropriate sooner.
- Daily skilled care. Your doctor decides you need skilled nursing or therapy every day, such as IV medicines or physical therapy.
- The right condition. Care is for a condition treated during the hospital stay, or a new one that started while you were in skilled nursing care for it.
- A certified facility. The facility is certified by Medicare as a skilled nursing facility.
Source: Medicare.gov, skilled nursing facility care.1
03Before discharge
Three questions to ask before you leave the hospital
Hospital discharges move fast. These questions protect your coverage and your choice of facility.
- Ask first
Am I an inpatient or under observation?
Observation days don’t count toward the 3-day stay, even overnight. If you are under observation for more than 24 hours, the hospital must give you a Medicare Outpatient Observation Notice. If you were admitted and then switched to observation, Traditional Medicare lets you appeal.
- Your choice
Which facilities can I choose from?
The hospital must give you a list of Medicare-participating facilities, share quality information about them and respect your choice when it can. Bring your own shortlist.
- Your rights
What if they say coverage is ending?
The facility must give you a Notice of Medicare Non-Coverage at least 2 days before covered care ends. To appeal, contact your Beneficiary and Family Centered Care Quality Improvement Organization by noon the day before.
Sources: CMS on the observation notice,3 Medicare.gov on status-change appeals4 and fast appeals,5 and federal discharge-planning rules.6
04Judging quality
How to judge a facility for a rehab stay
For a short stay, look first at the short-stay quality rating, then staffing, then the inspection record.
What the short-stay rating measures
CMS builds it from six measures of how residents on rehab stays fare:9
- Residents at or above the expected ability to care for themselves and move around at discharge
- Residents with new or worsened pressure ulcers
- Residents who got an antipsychotic medicine for the first time
- Residents re-hospitalized within 30 days of admission
- Residents with an emergency room visit within 30 days of admission
- Residents who returned home or to the community without an unplanned hospital stay or death in the 31 days after discharge
11,844 of 14,733 nursing homes have a short-stay rating (80%). CMS Provider Information, August 2026.
Staffing. Every nursing home profile shows registered nurse hours and total nurse hours per resident per day, and registered nurse turnover. Registered nurses handle assessments and care plans for complex patients, so RN hours matter for rehab.
Weekends. CMS's staffing rating counts weekend staffing,9 and weekend hours run lower on average: 3.42 nurse hours per resident per day against 3.86 over the whole week. Ask who covers nights and weekends.
Therapy. Ask how many days a week and how long therapy sessions run, and who decides when you're ready to go home.
05Red flags
Red flags to check before you choose
None of these rules a facility out on its own. Each is a reason to ask harder questions, or to keep looking.
A 1- or 2-star health inspection rating
Even with better staffing or quality ratings, it means recent inspections found serious or widespread problems.
Recent or repeated penalties
Penalties aren’t limited to harm, but fines tied to harm or immediate jeopardy, or several within a year, deserve questions.
The abuse icon or Special Focus status
CMS flags nursing homes cited for abuse, and those in its program for persistently poor performers.
Low staffing with complex patients
A 1- or 2-star staffing rating is a mismatch for a facility that takes patients on IVs, wound care or ventilators.
High staff turnover
Nursing homes where more staff leave each year tend to score lower on CMS quality measures and star ratings.
A low short-stay quality rating
It summarizes how rehab patients fare: returning home, avoiding readmissions and pressure ulcers.
Turnover research: Zheng et al., 2022.10
06FAQ
Questions families ask
Does Medicare always pay for 100 days of skilled nursing?
No. Up to 100 days is the limit per benefit period, and Medicare pays only while you need daily skilled care. Many stays end sooner, when skilled care is no longer needed.
What is a benefit period?
It starts the day you are admitted as an inpatient in a hospital or skilled nursing facility and ends when you have had no inpatient hospital or skilled nursing care for 60 days in a row. A new benefit period brings a new 100 days.
Do I have to be improving for Medicare to keep paying?
No. Coverage depends on needing skilled care, not on improving. Skilled care to keep your condition from getting worse can be covered too.
Who pays the $217 daily coinsurance?
You do, unless another plan pays it. Medigap Plans C, D, F, G, M and N pay it in full, Plan K pays half and Plan L pays 75%; Plans A and B pay none of it. Plans C and F aren’t sold to people new to Medicare since 2020. Medicaid may pay it for people who qualify.
How is Medicare Advantage different?
Medicare Advantage plans must cover skilled nursing care but set their own rules: they may use networks, require approval before admission, charge different copays and waive the 3-day hospital stay. Ask the plan before you choose a facility.
How do I estimate my costs?
Use our Medicare 100-day calculator to see covered days and what you might owe for a planned stay.
07Sources
Where this guide comes from
Every rule and figure on this page, with a link to the original.
Written by the Care Ratings Team and reviewed by the TCR Editorial Team. Last reviewed . How our data works: methodology.
This guide is general information, not medical, legal or financial advice. Coverage rules change; check Medicare.gov or call 1‑800‑MEDICARE (1‑800‑633‑4227) about your own situation.
Next step
Find skilled nursing near you.
Compare short-stay ratings, staffing, inspections and member reviews before the discharge planner calls.
