Skilled Nursing Facility Coverage and the 3-Day Rule
Many seniors who break a bone cannot return home safely immediately after leaving the hospital. You may require physical therapy and daily medical care in a skilled nursing facility (SNF).
Medicare Part A covers rehabilitation in a skilled nursing facility if you meet strict qualification requirements. You must enter a Medicare-certified facility within 30 days of hospital discharge.
Understanding the 3-Day Inpatient Rule
Under Original Medicare, you must complete a medically necessary inpatient hospital stay of at least three consecutive calendar days. Medicare counts these days by midnights spent in an inpatient bed.
For patients recovering from a fracture, asking your physician about Medicare coverage for bone density tests can help diagnose underlying bone density issues early.
The day of hospital discharge does not count toward your three-day total. Time spent in the emergency room or under outpatient observation does not satisfy this requirement.
Review detailed guidelines on skilled nursing facility Medicare eligibility through Medicare Interactive before transferring to a rehabilitation facility.
Certain Medicare Advantage plans and federal models, such as CMS’s Transforming Episode Accountability Model (TEAM), waive this traditional three-day inpatient requirement in select partner facilities.
Daily Rehabilitation Costs and Coinsurance
For days 1 through 20 of a covered skilled nursing stay, Medicare Part A pays 100% of approved costs. Your daily coinsurance during this initial period is $0.
For days 21 through 100, out-of-pocket costs rise sharply. You must pay a daily coinsurance amount of $217.00 per day.
Most Medicare Supplement Insurance (Medigap) plans, such as Plan G, cover this $217.00 daily coinsurance in full. After day 100, Medicare stops paying, leaving you responsible for 100% of ongoing nursing costs.
Comparing Inpatient Hospital and Skilled Nursing Facility Costs
The table below summarizes your out-of-pocket cost-sharing responsibilities under Original Medicare for hospital stays and rehabilitation facilities during a single benefit period.
| Care Setting | Covered Timeframe | Your Out-of-Pocket Cost |
|---|---|---|
| Inpatient Hospital | Days 1–60 | $1,736 deductible per benefit period ($0 per day) |
| Inpatient Hospital | Days 61–90 | $434 per day coinsurance |
| Inpatient Hospital | Days 91–150 (Lifetime Reserve) | $868 per day coinsurance |
| Inpatient Hospital | Days 151+ | 100% of all hospital costs |
| Skilled Nursing Facility | Days 1–20 | $0 per day (after 3-day inpatient stay) |
| Skilled Nursing Facility | Days 21–100 | $217.00 per day coinsurance |
| Skilled Nursing Facility | Days 101+ | 100% of all nursing facility costs |
A benefit period begins when you enter a hospital as an inpatient. It ends only after you have lived without inpatient hospital or skilled nursing care for 60 consecutive days.
