Original Medicare pays for rehab in a skilled nursing facility (SNF) only after a hospital stay of at least three inpatient days, and time as an outpatient “under observation” does not count toward them. In 2026, days 1 to 20 cost nothing after the Part A deductible, days 21 to 100 cost $217 a day, and Medicare pays nothing from day 101. If the facility hands you a Notice of Medicare Non-Coverage, you can ask for a fast appeal, but you must call by noon the day before coverage ends.
Does Medicare pay for rehab in a nursing home after the hospital?
Yes, for a limited time and only if several conditions are met. Per Medicare.gov, all of these must be true:
- You have Part A and days left in your benefit period.
- You had a qualifying inpatient hospital stay of at least 3 days in a row.
- You enter a Medicare-certified SNF generally within 30 days of leaving the hospital.
- Your doctor or other provider decides you need daily skilled care, such as IV medications or physical therapy, for a condition treated in the hospital.
“Daily” has a specific meaning. The CMS Medicare Benefit Policy Manual says skilled services must be needed essentially seven days a week, or at least five days a week if the stay is based only on rehabilitation therapy. It also says coverage of care that maintains a person’s condition depends on the need for skilled care, not on whether the person is likely to improve.
What is observation status, and why does it matter?
Observation services are hospital outpatient services you get while a doctor decides whether to admit you. Medicare explains that you are an inpatient only when a doctor orders admission and the hospital formally admits you. You can sleep in a hospital bed for several nights and still be an outpatient. Observation and emergency room time do not count toward the three days.
| Admitted as an inpatient | Outpatient “under observation” | |
|---|---|---|
| How it starts | A doctor orders admission and the hospital admits you | You are in the ER or a hospital bed while the doctor decides whether to admit you |
| Counts toward the 3-day SNF rule | Yes. The count starts on the admission day and does not include the day you leave | No, even if you stay overnight |
| Who pays the hospital | Part A | Part B (outpatient services) |
| Notice you should get | “An Important Message from Medicare about Your Rights” | Medicare Outpatient Observation Notice (MOON), required if observation lasts more than 24 hours |
Medicare’s advice is to ask every day whether the patient is an inpatient or an outpatient, and you can ask the doctor, a hospital social worker or a patient advocate. Medicare says admission is generally appropriate when a doctor expects you to need at least two midnights of necessary hospital care, so ask what the doctor expects.
What if the hospital changed the status to observation?
Medicare says a court order gives you the right to appeal when a hospital changes you from inpatient to observation. While you are still in the hospital, that is a fast appeal. The filing window for past stays ended on January 2, 2026, so read that page or call 1-800-MEDICARE (1-800-633-4227) instead of assuming an old appeal is still open.
One exception: from 2026 through 2030, hospitals in a CMS payment model called TEAM may send patients who had certain surgeries (such as joint replacement, hip fracture repair or spinal fusion) to a qualified SNF without the three-day stay, per a Medicare contractor notice. Ask whether the hospital takes part.
How much does a skilled nursing facility cost on Medicare in 2026?
Medicare covers up to 100 SNF days in each benefit period. These are the 2026 amounts for Original Medicare:
| SNF days (per benefit period) | You pay in 2026 (Original Medicare) |
|---|---|
| Days 1 to 20 | $0 a day after the $1,736 Part A deductible, which you do not pay again if you already paid it for the hospital stay in the same benefit period |
| Days 21 to 100 | $217 a day |
| Day 101 and beyond | All costs |
Using all 80 days from day 21 to day 100 would come to $17,360. Ask whether the person has other coverage, such as a supplement or retiree plan, before assuming the whole bill falls on the family.
How is Medicare Advantage different?
Under a CMS rule, Medicare Advantage plans must follow Traditional Medicare’s coverage criteria, but costs and rules still differ by plan. Medicare.gov says plans may charge copayments during the first 20 days and may waive the three-day inpatient stay. Whether observation time blocks rehab coverage therefore depends on the plan. Confirm that the facility is in network and the stay is approved before the transfer, and ask the plan to put its answer in writing.
What is a Notice of Medicare Non-Coverage?
When Medicare coverage of SNF, home health or hospice services is about to end, you should get a “Notice of Medicare Non-Coverage” (NOMNC) at least two days before. It gives the last covered day and how to request a fast appeal. It is a coverage notice, not by itself a discharge order.
The reviewer is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). For New York, Commence Health (formerly Livanta) handles Region 2, with the phone line 1-866-815-5440. If your notice lists a different number, use that one.
How do I appeal when the facility says coverage is ending?
Medicare’s fast appeal rules for SNFs work like this:
- Find the date. Read the notice for the date coverage ends and the appeal instructions.
- Call the BFCC-QIO no later than noon the day before that date.
- Ask for the explanation. The facility must give you a “Detailed Explanation of Non-Coverage” by the end of the day it receives the QIO’s notice.
- Wait for the decision. The QIO decides by close of business the day after it gets the information it needs.
- Know the outcomes. If coverage is ending too soon, Medicare may keep paying, minus any coinsurance or deductible. If the QIO agrees it should end, you do not owe for services before the end date, but services after it may be your cost.
If you miss the deadline and have a Medicare Advantage plan, you can ask the plan for a fast reconsideration, but services are covered only if the decision is in your favor.
The facility says coverage ends but my mother is not ready. What now?
- Ask the nurse or therapist what skilled care she still needs each day and what has been tried.
- Ask the doctor whether he or she agrees that skilled care should stop, and pass that view on to the QIO.
- File the fast appeal while you work on the next steps.
- Ask the facility’s social worker for the discharge plan in writing: who helps at home, what equipment is needed, what training the family gets and who orders home health.
- If coverage ends and she still cannot go home safely, ask what the facility charges privately and whether Medicaid may apply. See how Medicaid covers home care in New York.
Free Medicare counseling is available through HIICAP at 1-800-701-0501.
Should we sign to leave Medicare Advantage for a rehab facility?
Do not decide under pressure. A plan change is a Medicare enrollment decision with set windows. Per Medicare.gov, you can move from Medicare Advantage to Original Medicare from October 15 to December 7 (coverage starts January 1) or from January 1 to March 31, and Special Enrollment Periods exist for events such as a move. Ask the facility to explain its request in writing, then call 1-800-MEDICARE or HIICAP before signing anything.
What happens after rehab: home health under Medicare
Medicare home health can continue skilled help at home. You must be homebound, need part-time or intermittent skilled care, and have a doctor or other provider who sees you in person and orders care from a Medicare-certified home health agency. Covered services include skilled nursing, therapy and a home health aide alongside skilled care, at no cost to you. Medicare does not cover 24-hour-a-day care at home, or custodial care when that is the only care you need. For details, read what Medicare covers for home care in New York.
Where does a home care aide fit after discharge?
Medicare home health is short and skilled. The hours between visits are where families struggle: bathing, dressing, meals, safe trips to the bathroom and medication reminders. That gap is where a private-pay home care aide typically fits, and Medicaid may pay for personal care for people who qualify. See our pages on post-surgery home care, personal care services, therapy at home, nurse services and stroke recovery at home. Equipment questions: how to get medical equipment in New York.
ProLife Home Care is a licensed home care agency in Brooklyn and Queens (New York State Department of Health licence #2572L001). To talk through what help at home could look like, call (718) 232-2777 or use our contact page. We cannot file your appeal or say what Medicare owes, but we can help plan the care.
Everything above was checked against Medicare.gov, CMS, the Commence Health QIO site and aging.ny.gov on 9 October 2026. This is general information, not legal or medical advice. Confirm your own situation with Medicare, your plan, your doctor or a HIICAP counselor.
Frequently asked questions
Does Medicare cover a skilled nursing facility after a hospital stay?
Yes, after a qualifying inpatient stay of at least 3 days, if you enter a Medicare-certified SNF generally within 30 days and need daily skilled care. Coverage lasts up to 100 days per benefit period.
Does time in observation count toward the 3-day rule?
No. Medicare.gov says observation and emergency room time before admission does not count, even overnight. Ask every day whether the patient is an inpatient or an outpatient.
How much does a skilled nursing facility cost on Medicare per day in 2026?
Days 1 to 20 are $0 after the $1,736 Part A deductible, days 21 to 100 are $217 a day, and from day 101 you pay all costs.
How long do I have to appeal a Notice of Medicare Non-Coverage?
Contact your QIO no later than noon the day before the termination date on the notice. In New York, Commence Health’s Region 2 line is 1-866-815-5440.
Does a Medicare Advantage plan follow the same rules?
Plans must follow Traditional Medicare coverage criteria, but copayments, networks and prior authorization differ, and some plans waive the 3-day stay. Check with the plan before the transfer.
The facility says coverage ends but is not discharging my parent. Who pays?
You do not owe for services before the end date on the notice, but services after that date may be your cost. Ask for the private daily rate in writing and ask whether Medicaid may apply.
Will Medicare pay for a home care aide after rehab?
Only partly. Home health can include an aide alongside skilled nursing or therapy for a homebound patient, but Medicare does not pay for 24-hour care or custodial care alone.
