Medicare pays for up to 100 days of skilled nursing facility care per benefit period. The first 20 days are fully covered after you meet the Part A deductible ($1,736 in 2026). Days 21 through 100 require a daily copay of $217 in 2026. After day 100, Medicare pays nothing.
What You Pay During Each Phase
The 100-day window breaks into three distinct cost tiers. During days 1 through 20, you pay $0 per day once you’ve paid the Part A deductible of $1,736 for 2026. This is the most generous stretch of the benefit, and for many people recovering from surgery or a serious illness, 20 days is enough.
If you need to stay longer, days 21 through 100 come with a daily coinsurance of $217 in 2026. That adds up quickly. A full 80 days in this tier would cost you $17,360 out of pocket. Many Medigap (supplement) plans cover part or all of this coinsurance, so check your policy if you have one. Medicare Advantage plans set their own cost-sharing rules, which may differ from Original Medicare.
From day 101 onward, Medicare coverage stops entirely. You’re responsible for the full cost, which at most skilled nursing facilities runs several hundred dollars a day or more.
The 3-Day Hospital Stay Requirement
You can’t go directly into a skilled nursing facility and expect Medicare to pay. To qualify, you must first spend at least three consecutive days as a hospital inpatient. The day you’re admitted counts, but the day you’re discharged does not. This rule has been in place for nearly 50 years under traditional Medicare.
Here’s the catch that surprises many people: time spent under “observation status” in the hospital does not count toward the three days, even if you’re sleeping in a hospital bed for several nights. Observation is technically an outpatient service, so those hours never satisfy the inpatient requirement. Hospitals are required to give you a written notice called the Medicare Outpatient Observation Notice (MOON) if you’ve been in observation for more than 24 hours, explaining your status and what it means for skilled nursing coverage. If you’re in the hospital and unsure whether you’ve been formally admitted, ask. The distinction can mean the difference between a fully covered rehab stay and paying entirely out of pocket.
What Counts as “Skilled” Care
Medicare only covers care that requires trained medical professionals. This includes things like wound care with sterile dressings, intravenous medications, physical therapy after a joint replacement, or monitoring of an unstable medical condition. The care must be medically necessary and meet accepted standards of medicine.
What Medicare does not cover is custodial care, which is help with everyday activities like bathing, dressing, eating, using the bathroom, or getting in and out of bed. Most nursing home care is actually custodial. If the only reason you’re in a facility is because you need help with daily living rather than skilled medical treatment, Medicare will not pay. This distinction is the single most common reason people are surprised by a bill. A facility can provide both skilled and custodial care at the same time, but once you no longer need the skilled component, coverage ends regardless of how many days remain in the 100-day window.
How Benefit Periods Reset
The 100-day limit applies per benefit period, not per calendar year. A benefit period starts the day you’re admitted as a hospital inpatient and ends when you’ve gone 60 consecutive days without receiving inpatient hospital care or skilled nursing care. Once those 60 days pass, a new benefit period begins, and a fresh 100-day skilled nursing allotment becomes available.
This means it’s technically possible to receive more than 100 days of skilled nursing coverage in a single year if your benefit period resets. However, each new benefit period also means paying the Part A deductible again, and you’d still need to meet the three-day hospital stay requirement before re-entering a skilled nursing facility under the new period.
What Happens if Coverage Ends Early
Medicare doesn’t guarantee all 100 days. Coverage can end whenever the facility and Medicare determine you no longer need skilled care or you’re no longer making progress. When that happens, the facility must give you a written notice called a “Notice of Medicare Non-Coverage” at least two days before your covered services end.
You have the right to challenge that decision through a fast appeal. To do so, follow the instructions on the notice no later than noon the day before the listed termination date. An independent reviewer, not the facility or Medicare, will examine your medical records, ask why you believe coverage should continue, and issue a decision by the close of business the following day. While the appeal is being reviewed, you generally won’t be charged for the disputed days. If the reviewer sides with you, coverage continues. If not, you become responsible for costs starting on the termination date listed in the original notice.
Practical Planning for a Skilled Nursing Stay
Most Medicare-covered skilled nursing stays are far shorter than 100 days. The benefit is designed for post-acute recovery, not long-term residence. If you or a family member is heading to a skilled nursing facility after a hospitalization, a few things are worth doing early. Confirm the hospital stay was classified as inpatient, not observation. Ask the facility’s admissions team to verify Medicare eligibility before the transfer. And review any supplemental insurance you carry, because the daily coinsurance from day 21 onward can become a significant expense over several weeks.
If a longer stay seems likely, it’s worth understanding what happens at the 100-day boundary. At that point, options typically include paying privately, qualifying for Medicaid if your income and assets fall below your state’s thresholds, or transitioning to home-based care. Facilities often have social workers or discharge planners who can help map out next steps well before coverage runs out.