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How Many Days Does Medicare Cover in a Rehab Facility?

Medicare covers up to 100 days at a skilled nursing facility. Learn more about what qualifies for coverage and what doesn't.
October 18, 2024
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Medicare covers “up to” 100 days if you have Medicare Part A (hospital insurance) and have days of “Skilled Nursing Facility” (SNF) coverage left in your benefit period, also known as a “spell of illness.” For those that qualify, the first 20 days are fully paid for by Medicare Part A, and days 21-100 are primarily paid for by Medicare but are subject to a patient responsibility of a daily co-pay amount of $204 per day (in 2024). Medicare will not cover beyond this point.

When Does Medicare Pay for a Skilled Nursing Facility?

Medicare Part A SNF coverage is generally available to qualified individuals who meet the following requirements: (1) admission to the facility is within 30 days of the date of hospital discharge; (2) the prior hospitalization was for at least three consecutive days, excluding the day of discharge; (3) the resident requires daily skilled nursing or rehabilitation services that can only be provided in a SNF; (4) the resident is admitted to the facility to receive treatment for the same condition(s) for which he was treated in the hospital; (5) a medical professional certifies that the resident requires daily skilled nursing care.

Coverage for rehabilitation under Medicare Part A is intended to be short-term. As mentioned, the first 20 days in the rehab facility are covered in full by Medicare. Some Medigap/Supplemental co-insurance policies will cover all or part of the $204 daily co-pay for days 21-100. But patients do not always qualify for the full 100 days of rehabilitation. After admittance to a facility, the patient is evaluated periodically. Once the facility determines that the patient no longer needs skilled care, coverage under the Medicare program ends. Furthermore, Medicare does not cover custodial care, only skilled care.

In circumstances where the patient does not fall into the category of needing rehabilitative or skilled care, but the family cannot bring their loved one home safely, Medicare does not pay for time to set up a discharge plan. Once Medicare terminates coverage, the patient needs to return to the community or start privately paying for care.

Does Medicare 100 Days Reset?

A patient can qualify for a new 100-day benefit period only after being out of a hospital or skilled nursing facility for 60 days in a row. It is a myth that Medicare pays for long term care in a nursing home. The only government program that pays for long term care in a skilled nursing facility is the Chronic Medicaid program which has its own rules for eligibility.

Navigating the various payment sources for rehabilitation and beyond can be complicated. Be sure to understand the coverage you have and seek the guidance of competent elder law professionals to advise on additional coverage.