Navigating the complexities of Medicare can be overwhelming, especially when it comes to post-hospital care and rehabilitation. One of the most important—and sometimes misunderstood—features of Medicare coverage is the 100-day limit for skilled nursing facility (SNF) care.

Whether you're planning ahead, caring for a loved one, or planning for a discharge and transition to in-home care, understanding the rules, eligibility, and limitations of this coverage is crucial.

What Is the Medicare 100-Day Skilled Nursing Limit?

Medicare Part A provides coverage for skilled nursing facility care for up to 100 days per benefit period when specific requirements are met. This benefit is not a permanent or long-term care solution; it’s designed to provide short-term, medically necessary care following a qualifying hospital stay. The 100-day limit is per “benefit period,” not per calendar year, and can reset if certain conditions are met.

Who Is Eligible?

To qualify for Medicare coverage in a skilled nursing facility, all of the following must apply:

• You have Medicare Part A and days left in your benefit period.

• You had a qualifying inpatient hospital stay. This means you were admitted as an in-patient (not observation) for at least three consecutive days, not counting your discharge day.

• You need daily skilled care. This care must be ordered by your doctor and must require the skills of a professional nurse or therapist.

• You enter a Medicare-certified SNF within 30 days of leaving the hospital.

• Your skilled care is related to the condition treated during your qualifying hospital stay or a new one that arose during your SNF stay.

What Counts as Skilled Nursing Facility Care?

The care provided in a skilled nursing facility goes beyond what most people can receive at home or in a typical nursing home. Services may include:

• Wound care

• Intravenous medication or therapy

• Physical, occupational, or speech therapy

• Monitoring of serious health conditions

• Daily injections or complex care planning

How the 100-Day Limit Works

Coverage Breakdown

Medicare’s coverage for SNF care follows a strict payment schedule:

What Happens When You Reach the Limit?

Once you reach 100 days of skilled nursing care within a single benefit period, Medicare stops paying for your stay. At this point, you are fully responsible for all costs associated with continued care in the facility.

If you’re discharged and don’t need skilled care or hospital care for at least 60 days, a new benefit period may begin. Should you then experience another qualifying hospitalization, you could receive another 100 days of SNF coverage.

Not Everyone Gets the Full 100 Days

It’s a common myth that everyone who qualifies will get 100 days in a skilled nursing facility. In reality, coverage is based on medical necessity and daily skilled care requirements. If your condition improves or you no longer need skilled care, Medicare coverage can end before the 100-day maximum. Only a small percentage of patients actually use all 100 days.

Limitations and Pitfalls: What Medicare Doesn’t Cover

• Long-term or custodial care: Medicare never covers extended stays needed solely for help with activities of daily living like bathing or dressing.

• Observation stays: Time spent in the hospital under “observation” or in the emergency department doesn’t count toward the three-day qualifying stay.

• Facility requirements: The skilled nursing facility must be Medicare-certified.

How to Plan for Care Beyond the Medicare Limit

Many families wonder what to do when the 100-day Medicare coverage is about to end, or if their loved one doesn’t qualify in the first place. Here’s what you can consider:

• Transition to in-home care: Post-rehabilitation, many people become good candidates for specialized in-home care, home health or therapy.

• Transitioning to assisted living: Moving into a facility or nursing home care can be helpful for families who need full-time supervision or on-site support.

• Consider long-term care insurance or Medicaid: Those needing custodial or extended care may explore other coverage options or apply for Medicaid if eligible.

• Review other Medicare programs: Medicare Advantage Plans may offer different rules or benefits related to skilled nursing coverage—it's worth checking your specific plan.

The Role of In-Home Care After a Skilled Nursing Facility

When the Medicare SNF benefit ends, it doesn’t mean you have to go it alone. In-home care is a vital resource for helping patients continue their recovery, maintain independence, and avoid rehospitalization. Quality home care can make the shift from facility to home much smoother while providing peace of mind for families.

Read more about how caregivers support post-hospital recovery here.

Conclusion

Understanding Medicare’s 100-day skilled nursing facility benefit—and its many nuances—can make a world of difference as you plan for post-hospital care. While the benefit provides essential support during recovery, it’s both temporary and conditional. For those preparing to return home, trusted providers like Clara Home Care can help you bridge the gap, offering compassionate in-home care so you or your loved one can continue healing safely and comfortably.

Clara Home Care helps families find, hire, and retain trusted independent caregivers—making it easier to bring long-term care home after a skilled nursing facility stay. For seniors discharging from SNFs who need continued support beyond what Medicare covers, Clara offers a flexible, affordable solution that ensures care doesn’t stop at discharge.

Need help navigating the transition from skilled nursing to home? Connect with Clara Home Care’s experienced team to explore personalized in-home care options and set your loved one up for a safe, supported recovery.