After the hospital

Skilled nursing: 100 days maximum, and the rules that end it sooner

Short answer: Medicare covers skilled nursing facility care after a qualifying hospital stay, up to 100 days per benefit period. Days 1 through 20 cost you nothing; days 21 through 100 cost $217 a day in 2026; after day 100 Medicare pays nothing. Two rules cause most of the trouble: you generally need a three-day inpatient hospital stay first, and time spent under observation does not count toward it, and coverage can end well before day 100 if the facility decides you no longer need skilled care. Both are challengeable, and knowing that is worth thousands.

By the Medicare Decoder team · Updated September 30, 2026 · 4-minute read · Figures are official CMS amounts, checked against CMS

Key takeaways

Coverage requires a qualifying inpatient hospital stay of at least three days; observation days do not count.
Days 1 to 20 are fully covered; days 21 to 100 cost $217 per day in 2026; nothing is covered after day 100.
The benefit period resets after 60 consecutive days without inpatient or skilled care.
Coverage often ends before day 100 when the facility says skilled care is no longer needed, and that decision is appealable fast.
You do not have to be improving to qualify; maintaining your condition or slowing decline counts as skilled care.

Jump to What qualifies you The cost ladder The three-day trap When they say you are done What happens after 100 days FAQ

What qualifies you

Four conditions have to hold: you had a qualifying inpatient hospital stay of at least three consecutive days, not counting the discharge day; you enter a Medicare-certified skilled nursing facility, generally within 30 days of leaving the hospital; a doctor certifies you need daily skilled care, meaning nursing or therapy that requires licensed professionals; and that care relates to the condition treated in the hospital or one that arose during the stay. Medicare Advantage plans can waive the three-day requirement, and some do, which is a genuine advantage worth checking in plan comparison, though Advantage plans typically require prior authorization for the stay instead.

The cost ladder

Days in the benefit period	What you pay (2026)
Days 1 to 20	$0
Days 21 to 100	$217 per day
Day 101 onward	Everything; Medicare pays nothing

A benefit period begins when you are admitted and ends after 60 consecutive days without inpatient hospital or skilled nursing care. A new benefit period can start a fresh 100 days.

Days 21 through 100 at $217 a day works out to roughly $17,400 if you use them all, which is precisely the exposure a Medigap policy covers in full and an Advantage plan translates into its own daily copays capped by the plan maximum.

The three-day trap

This is the most expensive misunderstanding in Medicare. A hospital can keep you for several nights under observation status, which is billed as outpatient care under Part B, and observation days do not count toward the three-day inpatient requirement. People spend four nights in a hospital bed, get transferred to a nursing facility, and discover Medicare will not pay a cent because they were never formally admitted. Hospitals must give you a written notice (the MOON) when you have been under observation more than 24 hours. If you receive one, ask the physician directly whether you can be admitted as an inpatient, and escalate to the hospital’s case manager. The full observation article covers how to push back while it still matters, which is during the stay rather than after the bill.

When the facility says you are done

Most people never reach day 100. Coverage commonly ends earlier because the facility determines skilled care is no longer necessary, and this is where two rights matter.

You do not have to be improving. Under the Jimmo settlement, skilled care that maintains your condition or slows decline qualifies; there is no legal "improvement standard." Facilities still cite one, and saying this out loud changes conversations.
You get a written notice and a fast appeal. Before coverage ends you should receive advance written notice, and you can request an expedited review by the Beneficiary and Family Centered Care Quality Improvement Organization, which decides quickly, often within a day or two, while you remain in place. The appeal levels explain the process; free help is available through SHIP counselors.

What happens after 100 days

Medicare stops paying, and the bill becomes private, which is where families collide with the reality that Medicare is not long-term care insurance. Options at that point: private payment, long-term care insurance if a policy exists, Medicaid if the person qualifies financially (rules vary by state and spousal protections exist), VA benefits for eligible veterans, or moving home with home health services, which Medicare can cover separately under its own rules. The long-term care article lays out that whole landscape, and if the situation is turning toward end of life, hospice is a different and much more complete benefit. The benefit period rule matters here too: 60 consecutive days without inpatient or skilled care resets the clock, and a new 100 days becomes available if a new qualifying stay occurs.

Questions people also ask

How many days does Medicare pay for skilled nursing?

Up to 100 days per benefit period. Days 1 through 20 are fully covered, days 21 through 100 cost $217 per day in 2026, and Medicare pays nothing from day 101. A new benefit period, and a fresh 100 days, can begin after 60 consecutive days without inpatient or skilled care.

Do I need a three-day hospital stay for Medicare to cover a nursing facility?

Under Original Medicare, yes: a qualifying inpatient stay of at least three consecutive days, not counting the discharge day. Time spent under observation status does not count, even if you were in a hospital bed. Some Medicare Advantage plans waive this requirement.

Can Medicare stop covering skilled nursing before 100 days?

Yes, and it commonly does, when the facility determines you no longer need daily skilled care. You are entitled to written notice and can request an expedited review by the quality improvement organization, which usually decides within a day or two while you remain in the facility.

Does Medicare require me to be improving to keep coverage?

No. Under the Jimmo settlement, skilled care that maintains your condition or slows decline qualifies for coverage. There is no legal improvement standard, though facilities sometimes cite one incorrectly.

What happens after Medicare's 100 days run out?

You pay privately unless another source applies: long-term care insurance, Medicaid if financially eligible, VA benefits, or moving home with covered home health services. Medicare is not long-term care insurance, and this is where that distinction becomes concrete.

Sources for this article

Medicare.govSkilled nursing facility care: the qualifying stay, day limits, and cost sharing.
Medicare.govClaims and appeals: expedited review when coverage is ending.
CMS.gov2026 Medicare premiums and deductibles: the daily coinsurance amount for days 21 to 100.

Figures checked against these sources on September 30, 2026. We update within days when CMS publishes new amounts.

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