Medicare covers up to 100 days of skilled nursing facility care per benefit period, and when that coverage ends, you become responsible for the full daily cost of your stay. That can mean bills of $9,000 or more per month. But the transition doesn’t happen overnight, and you have rights, options, and in some cases the ability to appeal the decision or qualify for other programs that pick up where Medicare leaves off.
How Medicare’s 100-Day Limit Works
Medicare Part A covers skilled nursing facility care only after a qualifying hospital stay of at least three consecutive days. From there, coverage breaks into two phases. For days 1 through 20, you pay nothing beyond the initial Part A deductible ($1,736 in 2026). For days 21 through 100, you owe a daily coinsurance of $217 in 2026, while Medicare covers the rest.
After day 100, Medicare pays nothing. But many people lose coverage well before that 100-day mark. Medicare only pays for “skilled” care, meaning services like physical therapy, wound care, or IV medications that require trained medical professionals. The moment a facility or Medicare determines you no longer need that level of care, coverage stops, even if you still need help with daily tasks like bathing, dressing, or eating. That type of assistance is classified as custodial care, and Medicare does not cover it at any point.
The Notice You’ll Receive
Facilities can’t simply cut off your coverage without warning. Federal rules require them to deliver a written Notice of Medicare Non-Coverage (NOMNC) at least two days before your covered services are set to end. This form tells you the specific date coverage will stop and explains your right to appeal.
Pay close attention to the date on that notice. It triggers a tight deadline if you want to challenge the decision.
How to Appeal If You Disagree
If you believe you still need skilled care and Medicare is ending coverage too soon, you can request a fast appeal through an independent Quality Improvement Organization (QIO). The deadline is noon the day before the termination date listed on your notice. If you file on time, an independent reviewer evaluates whether your care still qualifies as skilled, and your coverage continues while the review is underway.
This is worth doing if your condition hasn’t meaningfully improved or if your care team believes you still need skilled services. The appeal is free, and the QIO is independent from both Medicare and the nursing facility. You typically get a decision within a few days. If the QIO sides with you, Medicare continues paying. If not, you can pursue additional levels of appeal, though coverage won’t continue during those later rounds.
What You’ll Pay Out of Pocket
Once Medicare coverage ends and you remain in the facility, you’re responsible for the full private-pay rate. Nursing home costs vary significantly by state and facility, but average rates for a semi-private room run roughly $300 per day, which works out to around $9,000 to $10,000 per month. Private rooms cost more. In expensive metro areas, monthly bills can exceed $12,000 to $15,000.
If you have a Medigap (Medicare Supplement) policy, it may cover some or all of the daily coinsurance during days 21 through 100. But once Medicare itself stops paying entirely, Medigap plans stop too. They only supplement Medicare-covered services. Long-term care insurance, if you purchased a policy before your stay, is the main private coverage option for custodial nursing home care.
The Facility Can’t Immediately Evict You
One of the biggest fears people have is being forced out the moment Medicare stops paying. Federal regulations protect against this. A nursing home must permit you to remain unless specific conditions are met, and simply switching from Medicare to private pay or Medicaid does not qualify as grounds for discharge.
A facility can begin discharge proceedings only if you fail to pay after receiving reasonable notice, and even then, they must follow a formal process that includes written notification, a chance to appeal the discharge, and help with transfer planning. CMS has specifically flagged payment-motivated discharges as a problem, noting that some facilities improperly push residents out when their payment source changes from Medicare or private pay to Medicaid. If a facility pressures you to leave without following the proper legal steps, you can file a complaint with your state’s long-term care ombudsman.
Transitioning to Medicaid
Medicaid is the primary safety net for people who can’t afford to pay for nursing home care out of pocket. Unlike Medicare, Medicaid does cover long-term custodial care. But qualifying requires meeting strict financial limits. Individual asset limits are typically around $3,000 (the exact figure varies by state), not counting your primary home in most cases, one vehicle, and certain other exempt resources.
If your assets exceed the limit, you’ll need to “spend down” by paying for your care until your countable resources fall below the threshold. This is where planning matters. Medicaid programs apply a 60-month look-back period, meaning they review all financial transfers you’ve made in the five years before your application. If you gave away money or assets during that window to try to qualify faster, Medicaid can impose a penalty period during which you’re ineligible for coverage.
For married couples, protections exist to prevent the spouse living at home from being left destitute. The community spouse is typically allowed to keep the home, a vehicle, and a portion of the couple’s combined assets and income. The specifics depend on your state, so it’s worth consulting an elder law attorney if you’re approaching this transition.
Resetting the 100-Day Clock
Medicare’s 100-day skilled nursing benefit isn’t a lifetime limit. It resets when a new “benefit period” begins. A benefit period ends once you’ve gone 60 consecutive days without being an inpatient in a hospital or skilled nursing facility. After that 60-day gap, a new benefit period starts, and you’re eligible for another 100 days of covered skilled nursing care, provided you again meet the qualifying criteria (a new three-day hospital stay and a medical need for skilled care).
This reset matters most for people with recurring conditions. If you’re discharged, spend at least 60 days at home or in an assisted living facility, and then need skilled nursing care again after another qualifying hospitalization, Medicare will cover a fresh 100-day period under the same cost-sharing structure.
Planning Before Coverage Ends
The most useful thing you can do is start planning before day 100 approaches. Talk to the facility’s social worker or discharge planner early in your stay. They can help you understand your likely discharge timeline, explore whether you qualify for Medicaid, and coordinate home health services or a lower level of care if you’re well enough to leave.
If returning home is realistic, Medicare does cover home health services separately from the skilled nursing benefit, as long as you’re homebound and need skilled care. This can bridge the gap between a nursing facility and full independence, covering visits from nurses, physical therapists, and home health aides on a part-time basis. For people who need ongoing daily assistance but not round-the-clock medical care, assisted living facilities offer a middle ground that costs significantly less than a nursing home, though Medicare doesn’t cover assisted living either.