When Medicare stops covering your rehab stay, you still have several options to continue receiving care or reduce the financial impact. The key is knowing exactly when and why coverage ends, because the next steps depend on your specific situation: whether you’ve hit the 100-day limit, whether your facility says you no longer qualify for skilled care, or whether you’re somewhere in between with rising daily costs.
How Medicare Rehab Coverage Works
Medicare Part A covers up to 100 days of skilled nursing facility (SNF) care per benefit period, but the coverage isn’t uniform across that window. Days 1 through 20 are fully covered after your Part A deductible. Starting on day 21, you owe a daily coinsurance of $217 (as of 2026) for each day through day 100. That adds up to $17,360 if you stay the full 80 additional days.
After day 100, Medicare pays nothing for your room, board, or nursing care. You’re responsible for the entire cost out of pocket, which at most skilled nursing facilities runs several hundred dollars a day.
It’s worth noting that most people don’t actually hit the 100-day ceiling. More commonly, the facility determines that you no longer need “skilled” level care, meaning your condition has stabilized enough that you don’t require daily therapy or nursing supervision. At that point, Medicare coverage ends regardless of how many days you’ve used.
Appeal the Discharge if You Disagree
If your facility tells you that Medicare coverage is ending and you believe you still need skilled care, you have the right to a fast appeal. The facility is required to give you a written “Notice of Medicare Non-Coverage” at least two days before your covered services are scheduled to end. That notice contains the instructions you need to file an appeal.
To keep your coverage in place while the appeal is reviewed, you must contact the independent reviewer (called a Beneficiary and Family Centered Care Quality Improvement Organization, or BFCC-QIO) by noon the day before the termination date listed on your notice. The number to call is printed on the form itself.
Once you file, the process moves quickly. The facility has to provide a detailed explanation of why they believe coverage should end. The QIO reviews your medical records, asks you why you think services should continue, and issues a decision by the close of business the day after receiving all the information it needs. If the QIO sides with you, your coverage continues. If not, you can pursue further levels of appeal, though you’ll typically be responsible for costs in the meantime.
This appeal is free and happens fast enough that it’s almost always worth filing if you genuinely believe you still need skilled rehabilitation. Many families don’t realize this option exists or miss the tight deadline, so pay close attention to any discharge notices you receive.
Check Whether Medigap Covers Your Coinsurance
If you’re between days 21 and 100 and struggling with the $217 daily coinsurance, check whether you have a Medigap (Medicare Supplement) policy. Several Medigap plans cover the SNF coinsurance in full, including Plans C, D, F, G, M, and N. Plan K covers 50% of it, and Plan L covers 75%. Plans A and B do not cover it at all.
If you enrolled in one of the more comprehensive Medigap plans before your rehab stay, your out-of-pocket cost for days 21 through 100 could be zero. Check your policy documents or call the number on your Medigap insurance card to confirm what’s covered.
Reset Your Benefit Period
Medicare’s 100-day limit applies per benefit period, not per year. A benefit period ends when you go 60 consecutive days without receiving any inpatient hospital care or skilled nursing facility care. Once those 60 days pass, a new benefit period begins, and you get a fresh 100 days of SNF coverage.
This means that if you leave a facility, spend 60 days at home or in a non-skilled setting, and then need skilled rehab again, Medicare will cover another round from day one. You would need a new qualifying inpatient hospital stay of at least three days to trigger SNF coverage under the new benefit period.
This isn’t something you can easily plan around if you need continuous care right now, but it’s important to know for the longer term. Some people cycle between home recovery and facility-based rehab across multiple benefit periods, especially after major surgeries or strokes.
Switch to Outpatient Therapy Under Part B
Even when Part A stops paying for your facility stay, Medicare Part B can still cover outpatient physical, occupational, and speech therapy. There is no annual dollar cap on medically necessary outpatient therapy. You pay 20% of the Medicare-approved amount after meeting your Part B deductible.
This is one of the most practical paths forward for people who are well enough to leave a skilled nursing facility but still need regular rehabilitation. You can receive therapy at an outpatient clinic, a therapist’s office, or sometimes at home through a home health agency. Your doctor or another qualified provider must certify that the therapy is medically necessary.
The transition from inpatient to outpatient therapy is common and doesn’t mean your rehab is over. Many people make significant progress in outpatient settings, where therapy sessions happen several times a week rather than daily.
Home Health Services as an Alternative
If leaving your home is difficult because of your condition, Medicare covers home health services at no cost to you: no copay, no coinsurance. To qualify, you must meet two conditions. First, you need part-time or intermittent skilled care such as nursing or therapy. Second, you must be “homebound,” meaning leaving your home takes considerable effort due to illness or injury, whether that means you need a wheelchair, walker, special transportation, or help from another person.
Being homebound doesn’t mean you’re confined to bed. You can still leave for medical appointments, religious services, or brief outings. You can even attend adult day care and still qualify. A healthcare provider must assess you in person and certify that you need home health services, and the care must come from a Medicare-certified home health agency.
Home health can include physical therapy, occupational therapy, speech therapy, skilled nursing, and medical social services. It won’t cover 24-hour care or help with daily tasks like bathing if that’s the only service you need, but for people transitioning out of a rehab facility, it can bridge an important gap.
Medicaid for Long-Term Care
If you need ongoing nursing facility care after Medicare coverage ends and can’t afford to pay privately, Medicaid may be an option. Medicaid covers long-term nursing home care for people who meet their state’s income and asset requirements, which are generally quite low.
Many people don’t qualify for Medicaid initially but become eligible through a process called “spend down.” In states that offer this, you use the difference between your income and your state’s Medicaid income limit to pay for medical expenses. Once your remaining income falls to the state’s threshold, Medicaid kicks in. Rules vary significantly by state: income limits, asset limits, and whether a spend-down program even exists all depend on where you live. Married couples face additional complexity, since the rules differ based on whether one or both spouses need Medicaid.
Applying for Medicaid while in a facility is common, and most nursing homes have staff or social workers who can help you start the process. If you have a spouse at home, protections exist to prevent them from being impoverished. An elder law attorney or your state’s Medicaid office can walk you through the specifics.
VA Benefits for Veterans
Veterans enrolled in VA healthcare may qualify for VA-funded nursing home care, community nursing homes, or home-based services. Eligibility depends on several factors: you must be enrolled in VA health care, the VA must determine you need the specific service for ongoing treatment and personal care, and the service must be available near you. Your service-connected disability status and income level also factor into the decision.
If you’re a veteran whose Medicare rehab benefits have run out, contact your local VA medical center to ask about long-term care options. VA benefits can sometimes fill gaps that Medicare and Medicaid don’t cover, particularly for veterans with service-connected disabilities.
Paying Out of Pocket
If none of the above options apply, private pay is the remaining path. Skilled nursing facilities typically cost between $250 and $400 or more per day depending on your location, which translates to $7,500 to $12,000 or more per month. Some families use long-term care insurance (if a policy was purchased years earlier), savings, or home equity to cover these costs.
Before committing to private pay at a facility, ask the care team whether your rehab goals could be met through less expensive options like outpatient therapy, home health, or adult day programs. In many cases, a combination of Part B outpatient therapy and home health services provides meaningful rehabilitation at a fraction of the cost of a continued facility stay.