For a skilled nursing facility (SNF), how many days does Medicare pay for a patient’s care? If you're responsible for admissions or resident care in an SNF, you need clear, no-nonsense answers — because delays and confusion can lead to financial headaches and disrupted transitions.

Medicare coverage for skilled nursing care follows strict rules, and once it runs out, facilities and families alike need a plan.

In this article, we’ll break down:

• How many days does Medicare pay for a skilled nursing facility 

• What happens when coverage ends

• Alternative payment options to keep care uninterrupted

How many days does Medicare pay for a skilled nursing facility?

Medicare provides coverage for skilled nursing facility (SNF) stays — but only for a limited time and under strict conditions. Many assume that Medicare automatically covers up to 100 days, but in reality, coverage depends on the resident’s ongoing need for skilled care.

Understanding these limits is essential for administrators managing resident transitions and financial planning.

Medicare’s 100-day rule

Medicare covers SNF care in benefit periods, which reset after a resident has spent 60 consecutive days outside of a hospital or SNF.

Within a single benefit period, Medicare pays for up to 100 days of skilled nursing care, but coverage is not guaranteed for the full duration. Residents must meet specific eligibility criteria, and coverage phases out over time:

• Days 1–20: Fully covered by Medicare (Medicare Advantage Plans may charge copayments).
  
  

• Days 21–100: Daily copay required ($209.50 per day in 2025).
  
  

• After 100 days: No Medicare coverage; alternative payment needed.

ExaCare helps skilled nursing facilities navigate Medicare’s complex reimbursement landscape by providing financial decision support. Its AI-driven tools analyze referral data, identify potential reimbursement gaps, and flag high-cost resident risks, ensuring administrators make informed admission decisions.

By offering clear financial insights, ExaCare helps facilities plan for coverage limitations, reducing unexpected financial burdens when Medicare benefits run out.

What qualifies a resident for Medicare coverage in an SNF?

To qualify for Medicare coverage in an SNF, a resident must:

• Have spent at least three consecutive days in a hospital (not counting discharge day)
  
  

• Be admitted to the SNF within 30 days of hospital discharge
  
  

• Require daily skilled care that must be provided by or under the supervision of licensed professionals
  
  

• Have a doctor’s order stating that skilled nursing care is necessary

How long can you stay in a skilled nursing facility?

Technically, Medicare covers up to 100 days per benefit period, but this doesn’t mean every resident receives the full 100 days. Coverage continues only if the resident meets ongoing eligibility requirements, such as:

• Medical necessity: The resident still needs skilled nursing or therapy services.
  
  

• Improvement standard: Medicare no longer requires a resident to be improving — coverage may continue as long as skilled care is necessary to maintain function or prevent decline.

If a resident no longer qualifies for skilled care under Medicare standards, coverage can end before 100 days, which is why facilities must closely track resident progress and plan accordingly.

What happens when Medicare coverage runs out?

When a resident reaches day 101 — or Medicare determines they no longer need skilled care — Medicare stops paying for their SNF stay. At this point, facilities and families must explore other payment options, such as:

• Medicaid (if the resident qualifies)

• Private pay (out-of-pocket expenses)

• Long-term care insurance (if applicable)

• Medicare Advantage plans (some may offer extended coverage)

Facilities that fail to plan ahead risk resident financial distress and administrative challenges. ExaCare’s AI-driven financial tracking tools help ensure smooth transitions by alerting administrators before Medicare benefits run out, giving them time to coordinate Medicaid applications, private pay arrangements, or alternative coverage options.

Can Medicare coverage be extended beyond 100 days?

Standard Medicare does not cover SNF stays beyond 100 days in a benefit period. However, some residents may qualify for additional coverage through:

• Medicare Advantage plans (Part C): Some offer extended SNF benefits beyond traditional Medicare
  
  

• Medicaid: If the resident meets income and asset limits, Medicaid can step in to cover continued SNF care
  
  

• Appeals process: If Medicare denies continued coverage, the resident or facility can appeal the decision

Administrators should be proactive in assessing coverage expiration and exploring alternative payment sources before residents reach day 101.

With the right planning tools — like ExaCare’s financial decision support and reimbursement analysis — facilities can anticipate coverage gaps, assess cost risks, and coordinate smoother resident care transitions.

How Medicare pay works: Skilled nursing (SNF) vs. long-term care 

Medicare covers SNF care under specific conditions, but it does not cover long-term care. This is a common point of confusion for residents, families, and even some healthcare administrators. Understanding the difference between these two types of care is crucial for managing expectations and planning for coverage gaps.

The differences between skilled nursing vs. long-term care

• Which is covered by Medicare? 

  • SNF care is covered, but only for up to 100 days per benefit period and only if the resident meets eligibility criteria.

  • Long-term care is not covered. Medicare does not cover long-term or custodial care.
    
    

• What type of care is provided?

  • SNF provides short-term, medically necessary skilled care, such as therapy, IV medications, and wound care.

  • Long-term care helps with daily activities (bathing, dressing, eating, mobility), but there is often no skilled medical care.
    
    

• What types of settings are they?

  • Skilled nursing facilities are often within a nursing home or hospital.

  • Long-term care is provided in nursing homes, assisted living facilities, or in-home care.
    
    

• What’s the duration of coverage?

  • At SNFs, get up to 100 days per benefit period, but only while the resident meets Medicare’s skilled care criteria.

  • At long-term care facilities, residents must rely on Medicaid, private funds, or long-term care insurance.
    
    

• Who qualifies?

  • SNFs support patients recovering from surgery, stroke, or illness who require daily skilled medical care.

  • Long-term care is for individuals with chronic conditions or disabilities who need long-term assistance with daily activities.

Administrators must be aware that Medicare coverage ends when skilled care is no longer medically necessary, even if the resident still requires assistance with daily living. This is why planning for alternative payment options is critical.

Common misconceptions about Medicare coverage

Many SNF administrators encounter families who assume Medicare will pay for long-term nursing home stays. Here are a few common misconceptions to clarify:

• Myth: Medicare covers all nursing home costs.
  Reality: Medicare only covers short-term skilled care (up to 100 days per benefit period) and does not cover custodial or long-term care.
  
  

• Myth: Every resident gets 100 days of SNF coverage.
  Reality: Coverage can end before 100 days if the resident no longer meets Medicare’s medical necessity criteria.
  
  

• Myth: Medicare will pay for a nursing home stay if a resident can’t live independently.
  Reality: Medicare does not cover long-term care, even if the resident needs 24/7 assistance.
  
  

• Myth: Medicare will cover SNF stays with no hospital admission.
  Reality: A resident must have a qualifying 3-day hospital stay before being eligible for Medicare-covered SNF care.

These misconceptions often lead to billing disputes and last-minute financial struggles, making it essential for facilities to educate families early in the process.

Services that Medicare covers in an SNF

When a resident qualifies for Medicare-covered SNF care, Medicare will pay for the following:

✅ Semi-private room (shared with another resident)
✅ Meals
✅ Skilled nursing care (provided by licensed nurses)
✅ Physical, occupational, and speech therapy
✅ Medical social services
✅ Medications and medical supplies used in the facility
✅ Ambulance transportation (when necessary for medically required services)
✅ Dietary counseling

However, Medicare does not cover:

❌ Private rooms (unless medically necessary)
❌ Personal care items (toiletries, laundry services, television, phone)
❌ Custodial care when it’s the only type of care needed
❌ Long-term nursing home stays

Because coverage depends on ongoing medical necessity, facilities need to track when residents no longer meet Medicare’s criteria and plan for alternative payment options accordingly.

Does Medicare pay for skilled nursing? What happens when Medicare stops paying?

Medicare only covers up to 100 days of SNF care per benefit period — and that’s only if the patient continues to meet Medicare’s medical necessity criteria. Once coverage runs out, facilities and families must decide who pays next.

Here’s what that involves:

• Patients must find a new way to pay: Medicare stops covering SNF care after 100 days per benefit period, leaving patients responsible for costs.
  
  Without a plan, this can lead to coverage gaps, financial strain, and disrupted care. Facilities should prepare for this transition early to avoid last-minute complications.
  
  

• Payment options after 100 days vary: Some patients may have Medicare Advantage (Part C) plans that extend SNF coverage, but this varies by provider. Medicaid covers long-term care for eligible patients, but qualification depends on income and asset limits.
  
  If Medicaid isn’t an option, patients must either pay out-of-pocket or rely on long-term care insurance if they have a policy that covers extended SNF stays.
  
  

• Medicaid eligibility requires planning: To qualify, patients must meet strict financial and medical requirements set by their state. The process can take time, so facilities should help families start applications early.
  
  Without Medicaid approval in place, SNFs risk unpaid bills and extended patient stays without reimbursement.
  
  

• Administrators should plan ahead: Tracking Medicare-covered days and communicating payment options with families before day 101 can prevent unexpected coverage gaps.
  
  If Medicaid is a likely next step, early coordination is essential to avoid financial disruptions.

ExaCare’s AI-powered financial and admissions tools help skilled nursing facilities stay ahead of Medicare coverage limits by providing real-time insights into reimbursement risks and patient eligibility.

Our decision-support system analyzes referral data, highlighting Medicaid eligibility, private pay risks, and potential reimbursement gaps — allowing facilities to plan proactively instead of reacting to last-minute coverage terminations.

With these tools, SNFs can navigate Medicare limitations more efficiently, improve financial stability, and facilitate smoother patient transitions.

Frequently Asked Questions

What if a resident leaves the skilled nursing facility and returns?

If a resident is discharged from an SNF and returns within 30 days, they may resume their Medicare-covered stay without needing a new hospital admission, as long as they still meet Medicare’s eligibility criteria for skilled care.

However, if they’ve been out of an SNF for 60 consecutive days, their benefit period resets, and they must meet the three-day hospital stay requirement again before qualifying for a new Medicare-covered SNF stay.

Does Medicare cover in-home nursing care?

Medicare Part A and Part B cover limited in-home nursing care, but only when a patient meets homebound status and requires intermittent skilled nursing or therapy services. This includes services like wound care, injections, and physical therapy, but it does not cover 24/7 custodial care, meal delivery, or personal assistance unless skilled care is also required.

Home health services must be provided by a Medicare-certified home health agency, and coverage typically lasts only as long as skilled care is deemed medically necessary.

Can teams appeal a Medicare coverage denial?

Yes, if Medicare denies SNF coverage, facilities or residents can appeal the decision by requesting a redetermination from the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).

If denied again, appeals can escalate through multiple levels, including Medicare Administrative Contractors (MACs) and even federal court review. Success depends on strong medical documentation proving continued need for skilled care, so facilities should ensure thorough and timely records before submitting an appeal.

What role does Medicare Advantage play in skilled nursing coverage?

Medicare Advantage (Part C) plans replace traditional Medicare and often have different SNF coverage rules, prior authorization requirements, and provider networks.

While some plans offer coverage beyond 100 days or have different co-pay structures, they may also require pre-approvals and stricter eligibility criteria for skilled nursing stays. SNFs should verify plan specifics upfront to prevent unexpected coverage denials and delays in care transitions.

ExaCare for skilled nursing facilities

Medicare’s coverage rules can be complex, but the right technology simplifies the process. We’re here to do more than help with answering questions like how many days Medicare pays for a skilled nursing facility.

ExaCare helps skilled nursing facilities stay ahead of coverage limits, manage financial transitions, and optimize resident care with AI-powered insights and automation.

Here’s what we offer:

1. AI-powered referral screener that reviews hospital packets in minutes, enabling quick and accurate admissions decisions.
   
   

2. Centralized referral management that brings all your sources into one platform.
   
   

3. Built-in analytics to help you track performance and optimize your referral relationships.
   
   

4. Automated insurance verification, expensive med alerts, and reimbursement analyses to guard your bottom line.
   
   

5. A unified communication hub to streamline decision-making with colleagues.

Ready to see how ExaCare can help your facility win more referrals? Talk with our team to learn more.

Schedule a demo.