Medicare Part A covers institutional recovery services, including care received in a Skilled Nursing Facility (SNF) and an Inpatient Rehabilitation Facility (IRF). This program assists beneficiaries requiring intensive, short-term recovery following a qualifying hospital stay. Coverage duration is strictly defined by federal regulations, and the patient’s financial responsibility shifts based on the length of stay. Understanding these rules is necessary for navigating the costs associated with post-hospital rehabilitation.
Defining the Eligibility Requirements for Skilled Nursing Coverage
Medicare Part A coverage for a Skilled Nursing Facility stay requires specific non-financial requirements to be met first. The patient must have a prior qualifying inpatient hospital stay of at least three consecutive days, not including the day of discharge. Days spent under “observation status” do not count toward this three-day minimum.
Following the qualifying hospital stay, a patient must be formally admitted to the SNF generally within 30 days of the hospital discharge. The primary reason for the SNF stay must be the need for daily “skilled care” that can only be safely and effectively provided by licensed professionals. Skilled services typically include daily physical therapy, occupational therapy, speech-language pathology, or skilled nursing services such as intravenous injections and complex wound care.
The care being provided must be related to the condition that required the prior hospital stay, or a condition that arose while receiving care for the primary illness. A physician must certify that the patient requires and is receiving these skilled services on a daily basis. If a patient’s condition stabilizes to the point where only custodial care, such as assistance with daily living activities, is required, the Medicare coverage will cease, even if the 100-day limit has not been reached.
The 100-Day Maximum Benefit Structure
Medicare Part A limits coverage for skilled nursing care to a maximum of 100 days within a single “benefit period.” A benefit period begins the day a patient is admitted to a hospital or SNF and ends only after the patient has been out of both institutional settings for 60 consecutive days. If a patient is readmitted to a hospital or SNF before that 60-day break, they remain within the same benefit period and the original day count continues.
The financial structure of these 100 days is divided into two distinct phases. For the first 20 days of the SNF stay, Medicare Part A covers 100% of the allowed charges, meaning the patient pays nothing out-of-pocket, provided all eligibility criteria are met. This full coverage period is intended to support the initial, most intensive phase of rehabilitation and recovery.
After the initial 20 days of coverage, the patient’s financial responsibility changes significantly. For days 21 through 100 of the benefit period, the beneficiary is responsible for a daily coinsurance payment. For instance, the daily coinsurance amount for extended care services in a Skilled Nursing Facility was set at $204.00 for the year 2024.
Once a patient reaches day 101 within the same benefit period, Medicare Part A coverage for the SNF stay ends completely. The patient then becomes fully responsible for all subsequent costs of care, including room, board, and skilled services. To start a new 100-day benefit period, the patient must remain discharged from both a hospital and a Skilled Nursing Facility for 60 consecutive days.
Understanding Patient Costs and Financial Responsibility
The costs a patient incurs related to a Part A covered rehabilitation stay begin before the SNF admission itself. Before Medicare Part A covers the inpatient hospital stay that qualifies a patient for SNF care, the beneficiary must satisfy the inpatient hospital deductible. The Part A deductible, which was $1,632 in 2024, covers the patient’s share of costs for the first 60 days of hospital care within that benefit period.
The daily coinsurance for SNF days 21 through 100, which was $204.00 in 2024, represents the primary out-of-pocket cost during the extended recovery phase. Many beneficiaries mitigate this expense through supplemental insurance plans, such as Medigap policies or Medicare Advantage Plans (Part C). These plans may cover some or all of the daily coinsurance amount, thus reducing the patient’s liability.
Beyond inpatient and SNF care, physical, occupational, and speech-language therapy are often provided in an outpatient setting, which falls under Medicare Part B. Outpatient therapy has a different cost structure and does not count toward the 100-day SNF limit. For Part B services, the patient must first satisfy an annual deductible, which was set at $240 in 2024.
After the Part B deductible is met, the patient is then responsible for a 20% coinsurance of the Medicare-approved amount for all medically necessary outpatient therapy services. This distinction is important because a patient who no longer qualifies for a skilled Part A stay may still receive and be covered for necessary rehabilitation services through Part B.