Original Medicare pays for up to 100 days in a skilled nursing facility (SNF) in each benefit period, after a hospital stay of at least three inpatient days. In 2026 days 1 to 20 cost $0 after the Part A deductible, days 21 to 100 cost $217 a day, and from day 101 you pay all costs. Coverage can also end earlier, the day you no longer need daily skilled care, and when it does the options are private payment, New York Medicaid or going home with services.
How does Medicare cover a skilled nursing facility stay?
The benefit is short-term rehab and nursing, not a place to live. Per Medicare.gov, you must meet all of these:
- You have Part A and days left in your benefit period.
- You had a medically necessary inpatient hospital stay of at least 3 days in a row. The count starts on the day you are admitted as an inpatient and does not include the day you leave. Time under observation or in the emergency room does not count.
- You enter a Medicare-certified SNF generally within 30 days of leaving the hospital.
- Your doctor decides you need daily skilled care for a condition that was also treated during the hospital stay.
Some Accountable Care Organizations and some Medicare Advantage plans waive the 3-day rule. Observation status and what to do when a facility says coverage is ending are covered in our guide to Medicare rehab after a hospital stay and how to appeal.
How many days does Medicare pay, and what does each day cost in 2026?
Medicare counts SNF days within a “benefit period.” Medicare.gov says a benefit period begins the day you are admitted as an inpatient to a hospital or SNF and ends when you have gone 60 days in a row without inpatient hospital care or skilled care in a SNF. You pay the Part A deductible again in each new benefit period.
| SNF days in a benefit period | You pay in 2026 (Original Medicare) | Example for a 45-day stay |
|---|---|---|
| Days 1 to 20 | $0 a day after the $1,736 Part A deductible (not charged again if you already paid it for the hospital stay in the same benefit period) | $0 for 20 days |
| Days 21 to 100 | $217 a day | 25 days x $217 = $5,425 |
| Day 101 and beyond | All costs | Not reached |
A full 100-day stay therefore means up to $17,360 for days 21 to 100 (80 days x $217), plus any deductible. In a Medicare Advantage plan you may be charged copayments during the first 20 days, so ask the plan for its schedule.
A supplement may help. Medicare.gov’s Medigap chart has a row for SNF coinsurance, and Plans K and L pay 50% or 75% of it. Ask your insurer before assuming the full $217 is yours.
What does “skilled” care actually mean?
Medicare defines skilled care as nursing and therapy that can be done safely and effectively only by, or under the supervision of, professionals. It is the type of care that matters, not the diagnosis. The CMS Medicare Benefit Policy Manual, chapter 8 gives examples on both sides.
| Counts as skilled (examples in the manual) | Not skilled by itself (examples in the manual) |
|---|---|
| Intravenous feedings and intramuscular injections | Routine oral medications, eye drops and ointments |
| Inserting a suprapubic catheter | Routine care of an indwelling catheter or a colostomy |
| Therapy so complex that only a qualified therapist can perform it safely | General supervision of exercises the patient has already been taught |
| Skilled observation while a condition is unstable, for example heart failure | Help with dressing, eating and going to the toilet; turning in bed; routine care of incontinence |
The care must also be needed “daily.” The manual says that means essentially seven days a week, or at least five days a week when the stay rests only on rehabilitation therapy. If the only help needed is the right-hand column, Medicare calls it custodial care, and Medicare.gov says it does not pay for that kind of long-term care.
Do you have to be getting better to stay covered? The improvement myth
No. Under the Jimmo settlement, approved by a federal court on January 24, 2013, CMS states that coverage of skilled nursing and therapy in SNFs does not turn on a person’s potential for improvement but on the need for skilled care. Medicare.gov likewise says skilled care can be needed “to improve or maintain” a condition or to prevent or delay it from getting worse.
The limits are real. CMS says the settlement does not change other requirements, such as that services must be reasonable and necessary, or the statutory limits on benefit length. A resident who is stable but still needs a nurse or therapist every day can qualify. A resident who needs only supervision and personal help cannot. If a notice cites “no progress” as the only reason, ask for the reasoning in writing and see our appeal guide for the fast-appeal deadline.
What happens when Medicare stops paying for nursing home care?
Coverage ends in one of two ways: you use up day 100, or the care team decides you no longer need daily skilled care. Either way, you owe the facility’s private rate for later days unless another payer steps in. Medicare.gov is plain about it: for days 101 and beyond, “You pay all costs.” If you leave and later need a SNF again, a break of more than 30 days in skilled care means a new 3-day inpatient stay is needed, and a break of at least 60 days in a row starts a new benefit period with up to 100 days again.
When the notice arrives, work through this order:
- Get the last covered day in writing and the facility’s daily private rate, plus the date you must decide.
- Decide about an appeal. The deadline is short; see the appeal steps.
- Ask the facility’s social worker for the discharge plan: where the person goes, what equipment and training are needed, and who orders home services.
- Check other coverage: a Medigap policy, a retiree plan or long-term care insurance. Medicare.gov names private long-term care insurance and Medicaid as the other routes.
- Pick a path: Medicaid for a longer nursing home stay, or home with services (both below).
For free Medicare counseling in New York, HIICAP takes calls at 1-800-701-0501. If you are worried about the care inside a facility, the State’s Long-Term Care Ombudsman Program investigates resident complaints at 1-855-582-6769.
Does New York Medicaid pay for a nursing home after Medicare ends?
It can, if the person meets Medicaid’s financial and medical rules. These 2026 figures come from New York State Department of Health charts (GIS 26 MA/05 and GIS 26 MA/03):
| 2026 Medicaid figure | Amount |
|---|---|
| Resource level, one person | $33,038 |
| Home equity limit for nursing facility and community long-term care | $1,130,000 |
| Spouse living at home may keep (minimum) | $74,820 |
| Spouse living at home may keep (maximum) | $162,660 |
The spouse figure is the greater of $74,820 or the spousal share, up to $162,660. For long-term nursing home coverage, the State reviews transfers of assets in the 60 months before the person is both institutionalized and has applied. A 2015 State message adds that the review also applies when rehabilitation in a nursing home runs past 29 days. Ask an elder law attorney before giving away assets or retitling the house. Income counts too, and the rules differ from home care. Our guides to Medicaid spend-down and power of attorney and guardianship may help you prepare.
Can you go home instead? Home care options after a SNF stay
Many people can, if the home is safe and the help is lined up before discharge. Three routes cover different needs:
| Route | What it covers | Main catch |
|---|---|---|
| Medicare home health | Part-time or intermittent skilled nursing and therapy at home, and an aide only alongside that care, at $0 for covered services | You must be homebound; it does not cover 24-hour care or custodial care alone |
| Medicaid personal care (PCS or CDPAP) | Help with bathing, toileting, meals and housekeeping, through an agency or a self-directed aide | Medicaid eligibility, an assessment by the New York Independent Assessor Program and the Minimum Needs Requirement |
| Private pay home care | Aide hours you choose, including live-in or around-the-clock care | You pay the hourly cost |
Medicare’s home health rules are explained in our Medicare home health benefit guide, and the difference between those visits and daily aide help in home health care vs home care in New York. For personal care, the State’s PCS page says adults 18 and over need a community health assessment from the New York Independent Assessor Program (1-855-222-8350, TTY 1-888-329-1541), and that people 21 and over must meet the Minimum Needs Requirement, with exceptions for people already authorized or enrolled on September 1, 2025. See CDPAP eligibility and what Medicaid covers for home care.
For private costs, read what home care costs in New York. See also post-surgery home care and therapy at home.
ProLife Home Care is a licensed home care agency in Brooklyn and Queens (New York State Department of Health licence #2572L001). We do not run nursing facilities and cannot decide what Medicare owes, but we can help plan care at home after discharge. Call (718) 232-2777 or use our contact page.
Program rules and dollar amounts change each year. Everything above was checked against Medicare.gov, cms.gov, health.ny.gov, aging.ny.gov and ltcombudsman.ny.gov on 12 October 2026. This is general information, not legal or medical advice. Confirm your own situation with Medicare, your plan, a HIICAP counselor or an elder law attorney.
Frequently asked questions
What happens when Medicare stops paying for nursing home care?
You owe the facility’s private rate for days after the last covered day, unless another payer applies, such as Medicaid, a supplement or long-term care insurance. Some people go home with Medicare home health or Medicaid personal care instead.
Does Medicare pay for 100 days in a nursing home?
Not automatically. Medicare covers up to 100 days per benefit period, and only while you need daily skilled care. In 2026 days 21 to 100 cost $217 a day, and nothing is covered from day 101.
Does observation time count toward the 3-day rule?
No. Medicare.gov says observation and emergency room time before admission does not count, even overnight. Ask the hospital every day whether you are an inpatient.
Does Medicare stop paying when you stop improving?
No. Under the Jimmo settlement, CMS says SNF coverage depends on the need for skilled care, not the potential to improve.
Is the $217 daily amount per day or per stay?
It is per day, for each day from 21 to 100 in a benefit period. A new benefit period begins after 60 days in a row with no inpatient hospital or SNF skilled care.
Does Medicare pay for long-term care in a nursing home?
No. Medicare.gov says it does not pay for long-term or custodial care, such as help with bathing, dressing and using the bathroom. Medicaid or private insurance may.
Can I get Medicare home health after a SNF stay instead?
Yes, if you are homebound and need part-time or intermittent skilled care ordered by a doctor. Covered home health services cost nothing, but 24-hour care at home is not covered.
