Skilled Nursing Facility Bills: What Medicare Covers After a Hospital Stay

Original Medicare covers up to 100 days of skilled nursing facility (SNF) care in each benefit period if you first had a medically necessary inpatient hospital stay of at least 3 days in a row and you need daily skilled care. In 2026 you pay $0 a day for days 1–20, $217 a day for days 21–100, and all costs after day 100. Medicare doesn't cover long-term custodial care, which is help with daily activities like bathing and dressing.

What counts as skilled nursing facility care?

Skilled care is care that has to be given or supervised by licensed nurses or therapists, such as physical therapy after a hip replacement, intravenous (IV) medications, or wound care. Medicare.gov says you must need skilled nursing care or therapy to improve or maintain your condition, or to prevent or delay it from getting worse.

Medicare's SNF benefit is for short-term care after a hospital stay. It's separate from living in a nursing home long term.

What is the 3-day rule?

To qualify for SNF coverage in Original Medicare, you need a "qualifying inpatient hospital stay." Medicare.gov defines this as a medically necessary inpatient stay of at least 3 days in a row, starting the day you were admitted as an inpatient and not counting the day you leave.

This is where surprise bills can start. Medicare.gov says time spent under observation or in the emergency room before you're admitted doesn't count toward the 3 days, even if you stayed overnight.

So someone can spend three nights in a hospital bed, be classified as an outpatient under observation, and then find their nursing facility stay isn't covered.

There are exceptions. Medicare.gov notes you may not need the 3-day stay if your doctor is part of an Accountable Care Organization approved for a "3-Day Rule Waiver," and Medicare Advantage plans may also waive it.

Tip: While still in the hospital, ask, "Is my parent admitted as an inpatient, or here under observation?"

What will I pay for SNF care in 2026?

For each benefit period in Original Medicare:

The $217 daily coinsurance comes from the Centers for Medicare & Medicaid Services (CMS) 2026 fact sheet. Many Medigap plans cover all or part of SNF coinsurance. If you have Medicare Advantage, your plan sets its own costs and may require prior authorization.

Why did Medicare stop paying before day 100?

Coverage is "up to" 100 days. Medicare pays only while you need and get daily skilled care. If the facility decides you no longer need skilled care, coverage can end sooner.

When that happens, Medicare.gov says you should get a "Notice of Medicare Non-Coverage" at least 2 days before covered services end. If you don't get it, ask for it. You have the right to a fast appeal if you think coverage is ending too soon. Follow the instructions on the notice, which Medicare.gov says are due no later than noon the day before the end date on the notice.

Does a new benefit period reset the 100 days?

Medicare.gov says that if your break in skilled care lasts at least 60 days in a row, the current benefit period ends and your SNF benefits renew. You'd need another qualifying hospital stay to start SNF coverage again.

How do I check a SNF bill?

1. Confirm the qualifying stay. Check the hospital's Medicare Summary Notice (MSN) or ask the hospital for the inpatient admission date.
2. Count the days. Make sure the $217 daily coinsurance starts on day 21, not earlier.
3. Check the benefit period. If you had a SNF stay earlier in the same benefit period, those days count toward the 100.
4. Look for non-covered charges. As general guidance, extras like a private room, phone, or TV may be billed separately. Ask whether you agreed to them.
5. Match the MSN. Compare what the facility billed with the "maximum you may be billed" on your Part A MSN.
6. Check what Medigap paid. If you have a plan that covers SNF coinsurance, the bill should show it.

What if Medicare won't pay because the 3-day rule wasn't met?

Ask the hospital for its records showing when the inpatient order was written. If you believe you should have been an inpatient, you may have appeal rights. Medicare has an appeal process for some people who were changed from inpatient to observation status. A State Health Insurance Assistance Program (SHIP) counselor can explain your options for free.

Frequently asked questions

How many days of SNF care does Medicare cover?

Up to 100 days per benefit period, if you meet the requirements. You pay $0 for days 1–20 and $217 a day for days 21–100 in 2026.

Does observation time count toward the 3-day stay?

No. Medicare.gov says time under observation or in the emergency room before admission doesn't count.

Does Medicare pay for long-term nursing home care?

No. Medicare doesn't cover custodial care if that's the only care you need. Medicaid may help people who qualify.

Can I appeal if the nursing facility says coverage is ending?

Yes. Medicare.gov says you should get a "Notice of Medicare Non-Coverage" at least 2 days before covered services end, explaining how to ask for a fast appeal. If you don't get one, ask for it.

Want a second look at a nursing facility bill?

Bill Review Coach is a monthly medical bill review service for seniors and their families. Snap a photo of the facility bill and your Medicare notice, and we'll walk you through the day count, the coinsurance, and what to ask the billing office. You make the calls and write the emails; we help you know what to say.