Medicare and Skilled Nursing: The 3-Day Rule and the 100-Day Limit
Medicare can pay for a short skilled nursing stay after a hospital admission, but only under specific rules. Knowing them before discharge can save a family a large, unexpected bill.
When someone leaves the hospital still needing daily nursing care or therapy, the next stop is often a skilled nursing facility. Original Medicare (Part A) can cover that stay, but the coverage is narrower than many families expect. It is designed for short-term recovery, not long-term care, and it depends on a few conditions being met first.
The 3-day inpatient rule
To qualify under Original Medicare, the patient generally needs a qualifying hospital stay of at least three consecutive days as an inpatient. Two details trip families up:
- The day of discharge does not count. Inpatient days are counted from the day the doctor formally admits the patient.
- Time “under observation” does not count. A patient can spend several nights in a hospital bed and still be classified as an outpatient under observation. Hospitals must give a written notice (the Medicare Outpatient Observation Notice, or MOON) when a patient has been under observation for more than 24 hours. If you are unsure of the status, ask the care team directly: “Is my parent an inpatient or under observation?”
The move to the nursing facility usually also has to happen within 30 days of leaving the hospital, the care has to be related to the hospital stay, a doctor must certify that daily skilled care is needed, and the facility must be Medicare-certified.
What “skilled care” means
Medicare covers skilled care: services that need the training of a nurse or therapist, such as wound care, IV medications, or physical, occupational or speech therapy after a stroke or surgery. It does not cover a stay that is only custodial, meaning help with bathing, dressing, eating or moving around. Under a 2013 court settlement (Jimmo v. Sebelius), coverage cannot be refused simply because the patient is not improving; skilled care needed to maintain function or slow decline can still qualify.
How the 100 days work
Coverage is counted per benefit period, which starts on the day of a hospital or skilled nursing admission and ends once the person has gone 60 days in a row without inpatient hospital or skilled nursing care.
- Days 1–20: Medicare pays the full cost of covered care.
- Days 21–100: the patient owes a daily coinsurance amount, which Medicare sets each year ($217 a day in 2026). A Medigap or other supplemental plan may cover some or all of it. Estimate your cost with our Medicare calculator →
- After day 100: Medicare pays nothing for that benefit period.
“Up to 100 days” is a maximum, not a promise. Coverage ends as soon as the patient no longer needs daily skilled care, which for many people is well before day 100.
When the facility says coverage is ending
Before Medicare-covered services end, the facility must give a written Notice of Medicare Non-Coverage, normally at least two days in advance. If you disagree, you can ask for a fast appeal from the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) named on the notice. Request it as directed on the notice, generally no later than noon of the day before services are set to end. The facility should not bill for covered days while a timely fast appeal is being decided.
If you have a Medicare Advantage plan
Medicare Advantage plans must cover skilled nursing care, but they set their own rules. Many waive the 3-day hospital requirement, but most require prior authorization and use a network of facilities, and their daily costs can differ from Original Medicare. Call the plan before choosing a facility and confirm that the home is in-network.
What to ask before discharge
- Was the stay inpatient for at least three days, not counting the discharge day?
- Is the recommended nursing facility Medicare-certified and, if relevant, in the Medicare Advantage network?
- What skilled services will be provided, and how will the facility decide when they are no longer needed?
- What happens financially if the patient needs to stay after Medicare coverage ends?