How long does Medicare pay for nursing home care? The 100-day rule, explained
If a parent has just been hospitalised and the discharge planner is talking about "a short rehab stay", the number you will hear repeatedly is 100 days. It is the most quoted — and most misunderstood — figure in US long-term care. Medicare does cover up to 100 days of skilled nursing facility care per benefit period, but the conditions are strict, the coinsurance after day 20 is substantial, and the average covered stay is closer to 25 days than to 100. This guide walks through the rule as CMS actually writes it, what it costs in 2026, how to appeal an early cut-off, and what families should line up before the Medicare coverage ends.
The short answer
Under Medicare Part A, a Medicare-certified skilled nursing facility (SNF) stay is covered for up to 100 days within a single benefit period — provided the resident continues to need daily skilled nursing or skilled therapy. This is rehabilitation and short-term recovery coverage, not long-term care. The benefit resets only after you have been out of any hospital or SNF for 60 consecutive days, which starts a new benefit period.
The four conditions you must meet
All four must be true on the day of SNF admission and throughout the stay. (1) You have Medicare Part A with days left in your benefit period. (2) You had a qualifying inpatient hospital stay of at least three consecutive days — note that "observation status" days do not count, which catches many families off guard. (3) You enter a Medicare-certified SNF within 30 days of leaving the hospital, for a condition treated during that hospital stay. (4) A doctor certifies you need daily skilled nursing or skilled rehabilitation services that, as a practical matter, can only be provided in an SNF on an inpatient basis.
What you actually pay in 2026
Days 1–20: $0 — Medicare pays the full Medicare-approved amount. Days 21–100: a daily coinsurance of $209.50 per day (the 2026 figure published by CMS). Day 101 and beyond: you pay all costs. A Medigap (Medicare Supplement) plan typically covers the days 21–100 coinsurance in full; Medicare Advantage plans have their own cost-sharing schedule, often a daily copay that resets if you switch SNFs.
Why most stays end before day 100
The 100 days is a ceiling, not an entitlement. Coverage continues only while skilled care is medically necessary. Historically SNFs cut coverage the moment a resident stopped "improving". The 2013 Jimmo v. Sebelius settlement made clear that maintenance therapy — care that prevents decline — also qualifies, and that a plateau in progress is not a legal basis to end coverage. In practice, the average Medicare-covered SNF stay is about 25 to 30 days, and many families receive a "Notice of Medicare Non-Coverage" long before day 100. Read that notice carefully: it triggers your right to a fast appeal.
What happens on day 101 (or whenever Medicare stops paying)
Four paths cover what comes next, often in combination. (1) Private pay — the national median is around $315 a day for a semi-private room in 2026, with wide regional variation. (2) Long-term care insurance, if the resident bought a policy years earlier; check the elimination period, daily benefit, and inflation rider. (3) Medicaid, which is the largest payer of long-term nursing home care in the US — but only for residents who meet both medical-need and financial-eligibility rules in their state, typically after spending down most non-exempt assets. Applying takes weeks; start while Medicare is still paying. (4) Veterans benefits — Aid and Attendance can offset costs for eligible wartime veterans and surviving spouses.
Medicare Advantage is different
About half of Medicare beneficiaries are now in Medicare Advantage (Part C) plans. These plans must cover SNF care at least as generously as Original Medicare, but the rules are tighter in practice: most require prior authorisation, many waive the 3-day hospital stay requirement (good), and most restrict you to a network of contracted SNFs (limiting). A 2022 HHS OIG report found Medicare Advantage plans denied 13% of prior-authorisation requests that would have been approved under Original Medicare. If your plan denies SNF coverage, you have the same right to expedited appeal.
How to appeal a Medicare cut-off
When the SNF hands you a Notice of Medicare Non-Coverage (NOMNC), it lists the date coverage will end — typically two days later. To appeal: call the Beneficiary and Family Centered Care Quality Improvement Organisation (BFCC-QIO) for your state by noon the day before coverage ends. The QIO must rule within 72 hours; coverage continues without charge while they review. About 25 percent of expedited QIO appeals overturn the SNF's decision. If the QIO sides with the SNF, you can escalate to a second-level QIO review and ultimately to an Administrative Law Judge.
What to do in the first 48 hours of admission
Three concrete steps protect the family financially. First, confirm in writing that the stay qualifies under Part A — ask the SNF business office for a copy of the physician certification and the qualifying hospital dates. Second, ask the discharge planner for an estimated length of stay and the criteria the therapy team will use to decide when skilled care ends; this prevents surprise non-coverage notices. Third, if long-term care after Medicare looks likely, start a Medicaid application now. In most states the process takes 45 to 90 days and is back-dated to the application date, not the approval date — every week of delay is a week of private pay.
Frequently asked questions
Authoritative sources
Figures, rules and claims in this post are drawn from these official and independent sources.
- Skilled nursing facility (SNF) care coverage
Medicare.gov
- Medicare Benefit Policy Manual, Chapter 8 — Coverage of Extended Care (SNF) Services
Centers for Medicare & Medicaid Services
- Jimmo v. Sebelius settlement — maintenance therapy clarification
Center for Medicare Advocacy
- Appealing a SNF discharge — expedited QIO review
Medicare Rights Center
- Use of prior authorization in Medicare Advantage exceeded 46 million requests in 2022
Kaiser Family Foundation (KFF)
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About this post
Written and reviewed by the Nursing Home Match editorial team. We update posts as the underlying rules and data change. This post is general information, not personal medical, financial or legal advice — always confirm details on Medicare.gov Care Compare or My Aged Care before making decisions.