Medicare Part A covers short-term skilled nursing facility (SNF) care after a qualifying hospital stay, but the coverage has strict limits on days, costs, and what counts as "skilled" care. Understanding exactly what is covered, and what is not, can make a major difference in your out-of-pocket costs in 2026.
This guide covers the 2026 cost structure, eligibility requirements, what services are included, and how Medicare Advantage handles SNF stays differently from Original Medicare.
What Is a Skilled Nursing Facility?
A skilled nursing facility provides medically necessary care that requires licensed nurses or therapists, such as wound care, intravenous medications, physical therapy, occupational therapy, or speech therapy. SNFs are typically used on a short-term basis following a hospitalization.
A nursing home and a skilled nursing facility are not the same thing, even when they operate in the same building. Nursing homes provide long-term custodial care, which means help with daily activities like bathing, dressing, and eating. Medicare does not cover custodial care. Medicare only covers skilled care, and only when a doctor certifies that it is medically necessary.
This is one of the most common misunderstandings about Medicare: people expect it to pay for long-term nursing home stays and discover it does not. Medicaid is the program that covers long-term custodial care for people who qualify based on income and assets.
Medicare SNF Coverage: 2026 Cost Table
Medicare Part A covers SNF stays in segments, and your costs increase significantly after the first 20 days.
| Days in SNF | What You Pay (2026) |
|---|
| Days 1 to 20 | $0 (fully covered after Part A deductible) |
| Days 21 to 100 | $217 per day coinsurance |
| Days 101 and beyond | All costs (Medicare stops paying) |
The Part A deductible for 2026 is $1,736 per benefit period. If you already paid the Part A deductible during your hospital stay before entering the SNF, you do not pay it again for the SNF stay within the same benefit period.
The daily coinsurance from days 21 to 100 adds up quickly. At $217 per day, a 60-day stay in that window costs roughly $8,680. If you anticipate needing extended SNF care, a Medicare Supplement (Medigap) plan can cover part or all of this coinsurance depending on which plan you carry.
Eligibility Requirements for Medicare SNF Coverage
Medicare does not pay for SNF care automatically. You must meet four requirements:
1. You have Medicare Part A.
You must be enrolled in Medicare Part A, which covers inpatient hospital care and SNF stays.
2. You had a qualifying inpatient hospital stay of at least 3 consecutive days.
You must have been formally admitted as an inpatient at a hospital for a minimum of 3 consecutive days, not counting the day of discharge. Time spent in the hospital under "observation status" does not count toward this requirement, even if you were in a hospital bed for several days. This distinction matters: always ask your hospital whether you have been formally admitted or placed under observation.
3. Your SNF stay begins within 30 days of your hospital discharge.
You must enter a Medicare-certified SNF within 30 days of leaving the hospital. In most cases the transfer happens quickly, but if there is a gap longer than 30 days, Medicare coverage may not apply.
4. A doctor certifies that you need daily skilled care.
Your physician must certify that you require skilled nursing care or skilled therapy services on a daily basis. The care must also be related to the condition that was treated during your qualifying hospital stay.
TEAM Model Exception: 3-Day Rule Waiver (2026)
Starting January 1, 2026, patients in a TEAM (Transforming Episode Accountability Model) episode of care can receive SNF services without meeting the 3-day hospital stay requirement. Acute care hospitals participating in the TEAM model can discharge patients directly to a qualified SNF or swing bed provider. This waiver runs through December 31, 2030 and applies to participating hospitals only.
If your hospital is part of the TEAM model, ask your care team whether you qualify for direct SNF admission without the standard 3-day stay.
What Services Does Medicare Cover in a SNF?
When you qualify for Medicare SNF coverage, Part A covers the following services:
- Semi-private room
- Meals
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Medications related to your SNF care
- Medical supplies and equipment used in the facility
- Dietary counseling
Medicare does not cover a private room unless it is medically necessary, personal comfort items (like a telephone or television service), or custodial care when skilled care is no longer needed.
Coverage stops when one of these happens: you reach 100 days, your doctor determines skilled care is no longer necessary, or you are discharged from the SNF.
Understanding Benefit Periods
Medicare SNF coverage is organized by benefit periods, not calendar years. A benefit period starts the day you are admitted as an inpatient to a hospital or SNF. It ends when you have been out of a hospital and SNF for 60 consecutive days.
There is no limit on the number of benefit periods you can use in your lifetime. If you need SNF care again after being out for 60 days, a new benefit period begins and the 100-day clock resets.
Example:
- You are hospitalized on March 1, 2026, and discharged to a SNF on March 5.
- You leave the SNF on March 30 (after 25 days).
- Your benefit period ends 60 days after your discharge, which would be around May 29.
- If you are re-admitted after May 29, a new benefit period starts and you get another 100 days of potential SNF coverage.
Medicare Advantage and SNF Coverage
If you are enrolled in a Medicare Advantage (Part C) plan instead of Original Medicare, your SNF coverage works differently in a few important ways.
Medicare Advantage plans are required to cover the same SNF benefit as Original Medicare, meaning up to 100 days per benefit period. However, the specific cost-sharing structure may differ.
| Feature | Original Medicare | Medicare Advantage |
|---|
| Days 1 to 20 copay | $0 | Varies by plan (may have copay) |
| Days 21 to 100 copay | $217/day | Varies by plan |
| Prior authorization | Not required | May be required |
| Network restrictions | Any Medicare-certified SNF | Must use in-network SNF (HMO) or pay more (PPO) |
| Out-of-pocket maximum | None for Part A alone | Plan sets a cap |
The biggest differences to watch for with Medicare Advantage:
Prior authorization. Many MA plans require prior authorization before approving SNF coverage. If you do not get prior authorization and your plan requires it, coverage may be denied.
Network restrictions. HMO-type MA plans generally require you to use an in-network SNF. PPO plans typically allow out-of-network SNF stays at a higher cost. For emergency admissions, MA plans must cover care at the nearest appropriate facility.
Copays in the first 20 days. Original Medicare has no copay for days 1 to 20. Some MA plans do charge copays during this window. Check your plan's Summary of Benefits before assuming your first 20 days are free.
If you are approaching an SNF stay and are enrolled in a Medicare Advantage plan, contact your plan directly to confirm coverage terms, required authorizations, and which facilities are in-network.
What Medicare Does NOT Cover in a SNF
Understanding the exclusions is as important as knowing what is covered.
Medicare SNF coverage does not include:
- Long-term custodial care (help with bathing, dressing, eating when no skilled care is needed)
- Care in a facility that is not Medicare-certified
- SNF care that begins more than 30 days after hospital discharge
- SNF care when a doctor has not certified that skilled care is medically necessary
- Stays beyond 100 days in a single benefit period
- Personal items, private room upgrades, or non-covered amenities
Once Medicare stops covering your SNF stay, you are responsible for the full daily cost, which can range from $200 to over $400 per day depending on the facility and location.
Options When Medicare Coverage Ends
When you exhaust your 100 SNF days or your skilled care need ends, several options may help with ongoing costs.
Medicaid. Medicaid covers long-term nursing home care, including custodial care, for people who meet income and asset limits. If you have limited income and resources, Medicaid may pick up costs once Medicare coverage ends. Medicaid rules vary by state.
Medicare Supplement (Medigap). Certain Medigap plans cover the daily coinsurance for SNF days 21 to 100. Plan G and Plan N are popular options that can significantly reduce out-of-pocket costs during an extended SNF stay. Medigap does not extend coverage beyond 100 days.
Long-term care insurance. Private long-term care insurance can cover costs beyond what Medicare pays, including custodial care in nursing homes or at home.
Veterans benefits. If you are a veteran, the VA may cover skilled nursing and long-term care depending on your service history and disability rating.
How to Find a Medicare-Certified SNF
Not every nursing home or rehabilitation center is certified to accept Medicare. Before choosing a facility, confirm that it holds Medicare certification. Medicare's Care Compare tool at Medicare.gov lets you search for SNFs by location, compare quality ratings, and read inspection reports.
Quality ratings range from one to five stars and cover health inspections, staffing levels, and quality of care measures. A higher rating generally indicates better performance across these categories, though individual experiences vary.
Frequently Asked Questions
Does Medicare cover 100 days in a skilled nursing facility every year?
No. The 100-day limit applies per benefit period, not per calendar year. A benefit period resets after you have been out of a hospital and SNF for 60 consecutive days. You can use multiple benefit periods in a single year if you meet the eligibility requirements each time.
What is the SNF coinsurance cost for days 21 to 100 in 2026?
In 2026, the Medicare Part A coinsurance for skilled nursing facility care is $217 per day for days 21 through 100. Original Medicare pays the remaining cost during this window.
Does Medicare cover skilled nursing facility care with no hospital stay?
Generally, no. A qualifying inpatient hospital stay of at least 3 consecutive days is required. The TEAM model waiver is an exception starting in 2026 for patients at participating hospitals, allowing direct SNF admission without the 3-day stay requirement.
Does observation status count toward the 3-day hospital requirement?
No. Observation status is classified as outpatient care, even if you spend multiple nights in the hospital. Only formal inpatient admission days count. You can ask the hospital to change your status from observation to inpatient, and you have the right to appeal if you disagree with the classification.
Can I use any nursing facility if I have Medicare?
Only Medicare-certified skilled nursing facilities are covered by Part A. If you are in a Medicare Advantage plan, you may also need to use an in-network facility to get your plan's full coverage. Use the Medicare Care Compare tool at Medicare.gov to find certified facilities in your area.
Will Medicare pay for a nursing home if I need long-term care?
Not for custodial care. Medicare covers skilled nursing care only when it is medically necessary and meets all eligibility criteria. For long-term nursing home care that is primarily custodial, Medicaid is typically the payer of last resort for people who qualify based on income and assets.
What happens when my 100 SNF days are used up?
Medicare stops paying after 100 days in a benefit period. After that, you are responsible for all SNF costs. Options include Medicaid (if you qualify), long-term care insurance, or private pay. A new benefit period begins after you have been out of a hospital and SNF for 60 consecutive days, at which point the 100-day count resets.
How does a Medigap plan help with SNF costs?
Medigap Plan G covers the Part A coinsurance for SNF days 21 to 100, which is $217 per day in 2026. This can save thousands of dollars on an extended stay. Medigap plans do not add coverage beyond 100 days, and they only work alongside Original Medicare, not Medicare Advantage.
If you want to see what benefits programs you qualify for, including Medicare Savings Programs that help cover Part A and Part B costs, use the free eligibility screener at BenefitsUSA.org/screener. It takes a few minutes and covers 11 federal and state programs at once.
