Medicare covers short-term care in a skilled nursing facility (SNF). However, its SNF coverage has some limitations. There are certain factors to consider when preparing for the end of Medicare’s SNF coverage.
While Medicare does not cover long-term nursing home care, it does offer coverage for skilled nursing facility (SNF) care.
SNF care may suit individuals who are ready to leave the hospital but not quite ready to be home. During a stay in an SNF, a person has round-the-clock access to a healthcare team that can provide services such as wound care, physical therapy, IV administration, and more.
However, there are limits to Medicare’s coverage, including its duration. Under Original Medicare, a person only receives coverage for the first 100 days of SNF care.
This article discusses what type of SNF coverage Medicare offers and what happens when Medicare stops paying, including available options and how to ensure continuous, quality care.
Medicare covers SNF care under Part A. This part of Original Medicare is responsible for covering inpatient hospital care.
If you have a Medicare Advantage (Part C) plan through a third-party insurer, you will receive at least the same SNF coverage that Part A offers.
To qualify for SNF care, you need to meet the criteria that the Centers for Medicare & Medicaid Services (CMS) outlines. These include:
- having a qualifying inpatient hospital stay, for example, 3 consecutive days of admission before moving to an SNF
- entering the SNF within a month of leaving the hospital
- having a doctor’s order explaining the medical necessity of the SNF stay
- receiving care at a Medicare-certified facility
If you meet the criteria for SNF care, Medicare will cover all costs for the first 20 days of a benefit period. For days 20 to 100, you’ll have a copayment.
In 2025, the costs for SNF care are as follows:
- For the first 20 days: You pay $0 per day.
- For days 21 to 100: You pay $209.50 per day.
- For days 101 and after: You pay all costs.
After 100 days of inpatient SNF care, Medicare stops paying, and you become responsible for the full cost.
It’s also possible for Medicare to stop paying for SNF care before 100 days have passed.
If Medicare deems the services no longer medically necessary or considers the care you’re receiving to be custodial (meaning nonskilled and solely for assisting with daily living tasks), it will stop covering them.
If Medicare ends your coverage due to a lack of medical necessity, you’ll receive a letter called a Notice of Medicare Non-Coverage (NOMNC) detailing this decision. This letter should arrive at least 2 days before the end of coverage.
If you or your physician disagrees with this decision, you may issue a fast appeal to try to reinstate your coverage. There will be instructions in the NOMNC explaining how to file the appeal.
During a fast appeal, an independent reviewer will examine your case and make a judgment on the medical necessity of your care.
It’s important to contact the reviewer promptly using the details on the NOMNC (before 12:00 p.m. on your termination date) and forward them any necessary medical documentation from your doctor. This will give them time to issue a judgment before your coverage ends.
When Medicare coverage ends, you have a few options.
You may remain in the same facility and pay the day rate out of pocket. If you choose this option, the facility will send you a document called a Skilled Nursing Facility Advance Beneficiary Notice of Noncoverage (SNFABN) before it begins charging you.
This document includes information such as the date your coverage ended, your expected costs, and the reason for the termination of coverage.
If you don’t have alternative insurance and you have a limited income, you may qualify for cost assistance through your state. You may consider applying for Medicaid or a Medicare savings program (MSP). These programs can help relieve your out-of-pocket medical costs.
A program called Program of All-Inclusive Care for the Elderly (PACE) can assist qualifying individuals with nursing home costs. The state Medicaid office can supply further information.
Another option would be returning home. Medicare covers certain home health services, which may meet your needs.
Consider speaking with your healthcare team about whether home health services may be a suitable replacement for SNF care.
Medicare may end a person’s skilled nursing facility (SNF) care due to a lack of medical necessity or because they have spent more than 100 days in a facility in one benefit period.
Depending on the circumstances, you may be able to appeal Medicare’s decisions. If Medicare stops paying, you have various options.
You may stay in the facility and cover the full daily cost either out of pocket or with the assistance of supplemental insurance. Alternatively, you may move home or to a different type of facility.