Someone's in the hospital or seriously ill
What does Medicare cover after a hospital stay?
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Original Medicare covers skilled care after a stay: a skilled nursing facility for up to 100 days per benefit period, home health, and rehab. It does not cover help with daily living on its own.
What to do
- Ask whether the stay was inpatient for at least 3 days in a row, not counting the day of discharge. Time under observation or in the ER does not count.
- Ask the case manager what the doctor is ordering (a skilled nursing facility, rehab or home health) and check the place is Medicare-certified, and in network for a Medicare Advantage plan.
- Ask what the skilled need is on the order. Coverage lasts only while a nurse or therapist is needed.
- Know the costs: in a skilled nursing facility, days 1 to 20 cost $0 each benefit period, a daily copay starts on day 21, and after day 100 you pay it all.
What to say
Which care after the hospital is the doctor ordering, and has anyone confirmed it meets Medicare's coverage rules? Please send me that in writing.
Ask the case manager, and ask before the transfer is booked.
What to watch out for
This is a sensitive stepSmall details here can change the outcome, and some mistakes are hard to undo. We highly recommend a free 15-minute call with us before you decide.
Assuming Medicare pays for a nursing home. It pays for skilled care after a qualifying stay, for a limited time. Long-term help with bathing, dressing and meals is custodial care and is not covered.
Better done together
We’re here to help
What Medicare covers after the hospital depends on details that families are rarely told, like the type of stay and the number of days. We help you understand the options before discharge, so nothing important is missed.
Every situation is different, and these are sensitive moments, so we look at yours with care. We often see what others miss, and we never take commissions from insurance companies: the only thing we are working for is what is right for you.
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The rule behind it
Under Original Medicare Part A, a skilled nursing facility stay is covered for up to 100 days per benefit period, after an inpatient stay of at least 3 days in a row, and only while skilled care is needed. A new benefit period can start after 60 days in a row without skilled care. Home health is covered when a doctor certifies you are homebound and need part-time skilled care. Medicare Advantage plans must cover what Original Medicare covers, but can use networks, require prior authorization, and may waive the 3-day rule.
Sources
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Home health services
- Medicare.gov — Compare Original Medicare and Medicare Advantage
- Medicare.gov — Long-term care
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
Start with the free Kit. If your situation needs a person, the intro call is free too.