What Is a Skilled Nursing Facility?
A skilled nursing facility (SNF) is not the same as a nursing home. Medicare covers skilled nursing facility care when you need skilled medical services — things like wound care, physical therapy, occupational therapy, or speech therapy — after a hospital stay. It is not designed to cover long-term custodial care, like help with bathing or dressing, when no skilled care is needed.
The 3-Day Qualifying Hospital Stay
Before Part A will pay for a skilled nursing facility, you must first have a qualifying inpatient hospital stay of at least 3 days. According to Medicare & You 2026, this means 3 consecutive days as a formally admitted inpatient — not including the day of discharge.
If you were kept in the hospital under "observation status" rather than formally admitted as an inpatient, those nights do not count toward the 3-day qualifying requirement — even if you spent them in a hospital bed. This is one of the most common and costly surprises in Medicare. If a nursing facility stay may follow your hospital visit, confirm your admission status immediately. You are entitled to receive a written Medicare Outpatient Observation Notice (MOON) if you're under observation status.
What Part A Covers — Day by Day
Once you meet the qualifying hospital stay requirement and are admitted to a Medicare-certified skilled nursing facility, here is what Part A covers in 2026, according to the official Medicare cost sheet:
| Days in the SNF | Your Cost (2026) |
|---|---|
| Days 1–20 | $0 — fully covered by Part A |
| Days 21–100 | $217 per day coinsurance |
| Day 101 and beyond | You pay all costs — Medicare does not cover beyond 100 days |
These day counts apply per benefit period, not per calendar year. A benefit period begins the day you're admitted to the hospital or SNF and ends when you've been out of both for 60 consecutive days.
What Skilled Nursing Facility Care Includes
When Part A covers your SNF stay, it includes your semi-private room, meals, skilled nursing care, physical therapy, occupational therapy, speech-language therapy, medical social services, medications, and other services needed for your condition. Private rooms are not covered unless they are medically necessary.
The $217-per-day coinsurance from days 21 through 100 adds up quickly. Twenty days at $0, then suddenly $217 per day — that's over $6,000 for the next 28 days alone if you stay through day 48. Many people in this situation turn to Medigap plans, which may cover some or all of this coinsurance depending on which plan they have. Medicare Advantage plans also handle SNF costs differently — check your plan's details directly.
When Medicare Stops Paying
Medicare stops paying for skilled nursing facility care in two situations. First, if you've used all 100 days in a benefit period. Second — and this one catches people off guard — if your condition is no longer improving and you no longer need skilled care. Medicare's standard is that you must be making measurable progress with your therapy or skilled nursing treatment. If a facility determines you've plateaued, Medicare coverage can stop before 100 days.
If Medicare or a skilled nursing facility says your coverage is ending and you disagree, you have the right to appeal. You should receive a written notice called a Notice of Medicare Non-Coverage before your coverage ends. You can request a fast appeal — called an expedited review — and an independent organization will review the decision. Don't just accept the notice without understanding your options.
What Happens After 100 Days
After 100 days, Medicare Part A stops paying entirely. At that point, you're responsible for all costs. Long-term custodial nursing home care is generally not covered by Medicare at all — it's a common misconception that Medicare pays for nursing homes indefinitely. It does not. Long-term care insurance, Medicaid (for those who qualify), or private funds are typically what cover extended nursing home stays.
"I get calls from families who are panicking because a parent is in a skilled nursing facility and Medicare just stopped paying. Most of the time, it's because nobody explained the 100-day limit — or the fact that Medicare can stop earlier if skilled care is no longer needed. This is exactly the kind of thing I help people plan for ahead of time, so it's not a crisis when it happens."
Talk to Betsy — Free ConsultationHow Medigap Helps With SNF Costs
Some Medigap plans cover the Part A skilled nursing facility coinsurance — the $217 per day from days 21 through 100. This can make a significant difference if you or a family member faces an extended recovery. Which Medigap plans cover SNF coinsurance, and how much, depends on the plan type. Betsy can walk you through the options available in Massachusetts, Kentucky, or Florida without any carrier bias.