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Many older adults require rehabilitation after a hospital stay, whether to regain mobility after surgery, recover strength after an illness, or manage a chronic condition. For Medicare beneficiaries, this care often occurs in skilled nursing facilities (SNFs), which offer around-the-clock care and rehab services like physical or occupational therapy.
Medicare’s coverage for skilled nursing care is limited, both in terms of time and cost. So, how long does Medicare pay for rehab after a hospital stay? This guide will answer that question, focusing on rehabilitation services in skilled nursing facilities.
For those who are eligible, Medicare Part A provides coverage for up to 100 days of SNF rehab per benefit period. The amount it pays, and what the patient is expected to cover, depend on the duration of the stay.
Medicare’s skilled nursing facility coverage is based on “benefit periods”, which begin the day a patient is admitted to a hospital as an inpatient and end after the patient has gone 60 consecutive days without inpatient care. Within that benefit period, Medicare will cover up to 100 days of SNF rehab, but the coverage is tiered:
| Medicare Coverage Per Day | ||
| Days in SNF | Medicare Coverage | Cost to Patient |
| Days 1-20 | 100% of approved costs covered | $0 |
| Days 21-100 | Medicare pays all except daily coinsurance | Daily coinsurance (can vary) |
| After 100 days | No coverage | Responsible for all costs |
Let’s explore this further with an example. Susan, a 77-year-old Medicare beneficiary, falls and breaks her hip. After surgery and three days in the hospital, she’s transferred to a skilled nursing facility for rehabilitation, where she stays for 40 days before returning home.
Here’s how Medicare coverage would apply to Susan’s stay:
| Example of Medicare Coverage Per Day | |
| Days in SNF | Coverage |
| Days 1-20 | Susan is fully covered by Medicare, and pays $0 out of pocket |
| Days 21-40 | Susan still qualifies for skilled care, so Medicare covers most of the cost. She pays $204* per day in coinsurance. For these 20 days, her total out-of-pocket cost would be: 20 days × $204 = $4,080 |
*This number can vary based on state regulations and other factors
Note that in the table above, Medicare covers 100% of “approved costs” for the first 20 days. This means that a patient must qualify for coverage by meeting specific criteria. Next, we’ll break down exactly what that means.
While Medicare Part A does offer coverage for skilled nursing facility (SNF) rehab, eligibility isn’t automatic. There are three main requirements a patient must meet to secure Medicare-covered SNF care:
| Medicare Coverage Requirements | |
| Requirement | Details |
| 3-Day Hospital Stay Rule |
|
| Medicare-Certified SNF |
|
| Physician Certification |
|
To be eligible for SNF coverage, a patient must first have been admitted as an inpatient to a hospital for at least three consecutive calendar days, not including the day of discharge.
Here’s what’s important:
Many denied SNF claims are tied to confusion over this rule, particularly around observation stays.
To be eligible for Medicare coverage, the skilled nursing facility you transfer to must be Medicare-certified, which ensures it meets federal health and safety standards. Patients or families should ask whether a facility is Medicare-certified before agreeing to admission.
Even if a patient meets the hospital stay and facility certification requirements, Medicare will only cover their rehab if it’s medically necessary. A doctor must:
Daily skilled services may include:
Medicare coverage may end if the patient’s condition stabilizes and they no longer need daily skilled services, regardless of how many days they’ve used.
We’ve explained that Medicare coverage ends after 100 days, even if a patient still requires skilled nursing care. But there are two other reasons why Medicare coverage can lapse:
Coverage can end before 100 days if the patient no longer meets Medicare’s definition of “daily skilled care.” A physician (or the facility) must document that:
If a patient’s progress plateaus and the remaining services are mostly help with bathing and dressing, Part A payments stop immediately, even if only 10 days have elapsed.
Medicare’s 100 covered days are tied to a “benefit period” (also called a spell of illness), which starts with hospital admission and ends after 60 consecutive days in which the patient receives no inpatient hospital or SNF care.
The prior benefit period closes if the patient goes home and stays out of any hospital or SNF for 60 days. A new hospital stay of at least three inpatient days creates a fresh benefit period, resetting the 100‑day SNF allotment. Still, the patient must again meet all the original eligibility criteria.
If you still require skilled nursing care after 100 days, the cost of your care will no longer be covered by Medicare. However, there are options available. Medicaid-eligible patients can use Medicaid benefits to pay for the cost of care, while other patients use secondary insurance or private pay. The facility’s staff can explain your options and help you figure out the next steps to ensure your care continues.
So, how long does Medicare pay for rehab after a hospital stay? The short answer is 20 days, during which time Medicare covers 100% of the costs for eligible patients to receive rehab in a skilled nursing facility. From days 21 to 100, patients are responsible for paying a coinsurance, and after 100 days, patients are responsible for the entire cost.
Don’t hesitate to reach out to Nightingale if you have more questions about Medicare coverage or short-term rehabilitation in a skilled nursing facility. We accept Medicare, Medicaid, private insurance, and more.