What It Is

Inpatient care in a nursing or rehabilitation facility

What's Covered

Medicare Part A covers inpatient care in a skilled-nursing or rehabilitation facility under certain limited circumstances:

• A patient's stay must begin within 30 days of an inpatient hospital stay of at least three days.

• The patient must need, and have a physician's prescription for, daily skilled-nursing care or physical rehabilitation.

• Care must be in a Medicare-certified skilled-nursing or rehabilitation facility.

• Coverage lasts only while the patient's condition is improving. Once the patient's condition has stabilized, Medicare Part A will no longer cover inpatient care.

Note: Medicare doesn't cover long-term nursing home residence, or a stay of any length in a nursing facility for custodial care, or any level of care that doesn't meet all of the above-described conditions.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for inpatient care in a nursing or rehabilitation facility, contact the plan directly.

What Medicare Pays

For the first 20 days of coverage during any benefit period, Medicare Part A pays the full Medicare-approved amount. (A benefit period is the period during which someone is a hospital inpatient, plus the following period in a Medicare-covered skilled-nursing or rehabilitation facility. A benefit period begins on the first day in the hospital and continues until the patient has been out of the hospital and any other Medicare-covered nursing or rehabilitation facility for 60 consecutive days.)

For days 21 to 100 of a covered stay in a skilled-nursing or rehabilitation facility during any one benefit period, Medicare pays the full Medicare-approved amount, except for a daily coinsurance amount of $133.50 per day.

After 100 days in a skilled-nursing or rehabilitation facility in any one benefit period, Medicare no longer pays any of the cost.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

• The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

• The care must be performed or delivered by a healthcare provider who participates in Medicare.