Medicare Skilled Nursing Facility Coverage: 2026 Costs

Seniors Insurance Hub 2026-09-18

Opening answer (BLUF)

Original Medicare Part A can pay for a short stay in a skilled nursing facility after a qualifying hospital admission. The benefit is measured in a benefit period, not a calendar year, and it is capped at 100 days of skilled care in each period.[1] In 2026, you pay $0 for covered SNF services on days 1 through 20 (after the Part A deductible has been met for that period).[1][2] You pay $217 a day on days 21 through 100.[2] From day 101 on, you pay the full cost of the stay.[1][2][3]

That is the heart of Medicare skilled nursing facility coverage. It is short-term skilled nursing and therapy, not a promise to pay for a long nursing-home stay. Medicare does not cover custodial care when that is the only care you need, such as help with bathing, dressing, or eating.[5][6] Families around Greensboro and the Piedmont often hear “Medicare covers 100 days” and assume the first three months are free. The first 20 days can be. The next 80 days are not. Our team walks through these numbers so you know what Part A pays, what you still owe, and when the 100-day clock actually resets.

What Part A covers after a hospital stay

A skilled nursing facility (SNF) is a place to live for a limited time while you get rehabilitation and medical treatment after an illness or injury. Many nursing homes offer this level of care, and some hospitals have their own SNF unit. Part A covers that stay only when you meet every coverage condition, and only for a limited time.[1][11]

You must have Part A and unused SNF days in your current benefit period. You must have had a medically necessary inpatient hospital stay of at least 3 consecutive days (counting the admission day, not the discharge day). You generally must enter the SNF within 30 days of leaving the hospital. A doctor must decide that you need daily skilled care, such as intravenous medication or physical therapy, from or under the supervision of skilled nursing or therapy staff. The facility must be Medicare-certified. The skilled services must relate to a condition treated during that hospital stay, or to a new condition that started while you were already getting SNF care. You must need the skilled care to improve your condition, maintain it, or keep it from getting worse.[1]

If those pieces line up, Part A covers a semi-private room, meals, skilled nursing, physical therapy, occupational therapy, and speech-language pathology when they are needed to meet your health goal, plus medical social services, medications, medical supplies and equipment used in the facility, dietary counseling, and ambulance transport when other transportation would endanger your health.[1][7] If you are in the SNF for skilled therapy and not for daily nursing, Medicare still treats the care as daily when therapy is needed and provided 5 to 7 days a week.[7] Extra charges such as a personal phone or laundry stay with the family even on a covered day.[7]

What you pay on days 1-20, 21-100, and after day 100

The 100-day benefit has three cost layers. Medicare.gov states the 2026 amounts this way for each benefit period:[1][3]

Days 1-20: you pay $0 each day after you pay the $1,736 Part A deductible.[1][2] You do not pay that deductible again for the SNF stay if you already paid it for hospital care in the same benefit period.
Days 21-100: you pay $217 each day.[2]
Days 101 and beyond: you pay all costs.[1][3]

CMS published the same 2026 figures: the inpatient hospital deductible is $1,736, and the SNF daily coinsurance for days 21 through 100 is $217.00, up from $209.50 in 2025.[2]

Most people who qualify for SNF care have already met the Part A deductible during the hospital stay that came first. In that usual path, days 1-20 of a covered SNF stay really are $0 for the covered facility services.

Days 21-100 are where the bill changes. You pay $217 a day for each coinsurance day you use, at the 2026 CMS rate.[2] Extra facility charges are separate, and so is any time after the benefit days are used up. Many stays are shorter. A person who goes home on day 18 never sees the coinsurance layer. A person who needs six weeks of therapy will.

After day 100 in the same benefit period, Part A pays nothing more toward the SNF stay.[1][3][4] CMS puts it plainly: Part A covers up to 20 full days, then up to an additional 80 days with daily coinsurance, and after 100 days the SNF coverage for that period is exhausted.[4] Some Part B services, such as doctor visits, can still apply. That is a separate bill, not an extension of the 100-day stay.[5][4]

If you are in a Medicare Advantage Plan, the first 20 days may not be $0. A plan may charge copayments during those days, so check the plan rather than assume Original Medicare’s cost layers.[1] Original Medicare has no yearly cap on what you pay out of pocket unless you have other coverage, such as a Medigap policy.[3]

How a benefit period works (it is not a calendar year)

The 100 days do not reset on January 1. They reset when a benefit period ends.

CMS measures SNF coverage in benefit periods, sometimes called spells of illness. A period starts the day a hospital or SNF admits you as an inpatient. It ends after you have not been an inpatient of a hospital or SNF for 60 consecutive days. A new period does not start just because the diagnosis changed, or because a new calendar year began.[4] You can get up to 100 days of SNF coverage in a benefit period, and you pay the Part A deductible each time a new period starts, which can happen more than once in a calendar year.[7] There is no limit on the number of benefit periods you can have in a year.[3]

That 60-day break is the reset. Stay out of inpatient hospital and skilled SNF care for 60 days, and a later qualifying hospital stay can open a new 100-day SNF benefit. Leave for a shorter time and you are usually still in the same period, using whatever days remain.

Medicare’s booklet walks through the shorter breaks families actually use:[7]

A break of less than 30 days: you generally do not need a new 3-day inpatient hospital stay to resume covered SNF care, but you must still meet the other coverage rules. You only have the unused SNF days left in the current period.
A break of at least 30 days but fewer than 60: Medicare will not cover more SNF care unless you meet the coverage requirements again.
A break of 60 days or more: the current benefit period ends. If you later meet the coverage requirements, a new period can start with up to 100 SNF days.

CMS describes the same 30-day readmission path. If a SNF discharges you and you return for skilled care within 30 days, you can resume unused SNF days without another qualifying hospital stay. The same idea applies if you stay in the SNF for custodial care after a covered stay and then develop a new skilled need within 30 consecutive days after the first non-covered day.[4]

This is a per-period cap, not a lifetime cap. The practical question for a Piedmont family is not “Have we used our 100 days for life?” It is “Are we still in this benefit period, and how many days are left?”

Skilled care versus custodial care

This distinction decides whether Part A is paying at all, even on day 3 of a stay that looked covered.

Medicare defines skilled care as nursing and therapy that can only be performed safely and effectively by, or under the supervision of, professionals or technical personnel. It is care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and to evaluate that care.[1] CMS uses the same idea: a service is skilled if, because of its complexity, it can only be performed safely and effectively by skilled nursing or rehabilitation personnel.[4]

Custodial care is different. Medicare does not cover custodial care if it is the only care you need.[5] Long-term care (also called custodial care or long-term services and support) is mostly help with everyday tasks: dressing, bathing, using the bathroom, home-delivered meals, adult day health care, and transportation. Medicare does not pay for that non-medical long-term care, and neither does most health insurance, including Medigap.[6][10] Nursing homes can provide both short-term rehab after a surgery or illness and long-term help with daily living. Part A may cover the short-term skilled stay (up to 100 days in a Medicare-certified nursing home after hospitalization) when skilled care is medically necessary. It generally does not cover a long-term nursing-home stay unless you are receiving skilled nursing care.[5][11]

Two points help keep this straight. Needing help to get dressed does not, by itself, end a covered SNF stay. Coverage follows the skilled services, not the building’s sign. And coverage is not limited to people who are still “improving.” Medicare.gov says you must need skilled nursing or therapy to improve or maintain your current condition, or to prevent or delay it from getting worse.[1] If the facility later decides the stay is no longer skilled, you should receive a written Notice of Medicare Non-Coverage, and you can ask for a fast appeal.[7]

The 100-day clock and the skilled-care test run at the same time. You can run out of days while you still need skilled care, or lose Part A SNF coverage before day 100 if the care is no longer skilled. Neither result is a judgment about whether a parent still needs a safe place to live.

A brief word on hospital observation

This article is about what the 100-day benefit pays once you qualify. Qualifying still depends on an inpatient hospital stay, not on how many nights you spent in a hospital bed. Time you spend under observation or in the emergency room before you are formally admitted does not count toward the 3-day qualifying inpatient stay, even if you are there overnight.[1][8] If that is the question in front of you, we already wrote a separate guide to Medicare observation status and the 3-day rule. Ask the hospital each day whether you have been formally admitted as an inpatient. Then use the day-count costs in the sections above.

How Medigap and Medicare Advantage change what you owe

On Original Medicare, a Medicare Supplement (Medigap) policy is built to help with the share of cost Part A and Part B leave behind, including coinsurance.[10] Some Medigap policies pay all or some of the SNF coinsurance for days 21-100. Check the policy or call the company to confirm.[7] Medigap does not turn the 100-day SNF benefit into long-term nursing-home coverage. Medigap plans generally do not cover long-term care in a nursing home.[6][10] For a North Carolina side-by-side, start with our Medicare Supplement page.

Medicare Advantage is a different path. Plans must cover the same number of SNF days Original Medicare covers, and they may cover more. They often use their own networks, prior authorization rules, and copayments, including during the first 20 days.[1][4] If your parent has an Advantage plan, that plan’s Evidence of Coverage governs the stay. Our Medicare Advantage page is the place to begin that comparison. Confirm the facility is in the plan’s network before the transfer.

North Carolina families also have a free counseling option that does not sell insurance. The Seniors’ Health Insurance Information Program (SHIIP), at the North Carolina Department of Insurance, has counselors in all 100 counties. SHIIP counselors are not licensed agents and do not sell or endorse any product, plan, or company. You can reach SHIIP at 855-408-1212.[9] Medicare’s Care Compare tool lists nursing homes that include rehab services once you are choosing a facility.[11]

Practical takeaways

Original Medicare Part A covers up to 100 days of SNF care per benefit period, not per calendar year and not for a lifetime.[1][7]
In 2026, covered days 1-20 are $0 after the $1,736 Part A deductible is met for that period. Days 21-100 are $217 a day. Day 101 and after are your cost.[1][2][3]
You usually do not pay the Part A deductible again at the SNF if you already paid it for the hospital stay in the same benefit period.[1]
A benefit period ends after 60 consecutive days with no inpatient hospital care and no skilled SNF care. Returning within 30 days can often resume unused days. A 60-day break ends the period.[3][4][7]
Skilled care is nursing or therapy that needs licensed professionals. Custodial help with daily living, by itself, is not a Part A SNF benefit. Coverage can continue when skilled care is needed to maintain a condition or slow decline, not only when you are still improving.[1][5][6]
Some Medigap policies pay the days 21-100 coinsurance. Medicare Advantage plans may charge copays even in the first 20 days. Track the day count yourself. The facility is not required to give written notice solely because the 100 days are used up.[1][7]

How we can help

Have more questions or want to get in touch? At Seniors Insurance Hub, our team helps Greensboro and Piedmont families read a SNF estimate calmly, with the 2026 numbers in hand, and without pressure. We can look at whether you are on Original Medicare with a supplement, or on a Medicare Advantage plan, and map the days 1-20 and 21-100 costs to the coverage you actually have.

Contact our team and we will be glad to walk through it. Prefer to speak with a member of our team? Call (336) 937-7501. We are available during our business hours to assist you, and we look forward to hearing from you.

This article is general information for Greensboro and Piedmont families, not medical, legal, or coverage advice. Confirm your own stay with the hospital, the skilled nursing facility, your plan, a North Carolina SHIIP counselor, or Medicare before you make a decision.

Citations

Medicare.gov: "Skilled nursing facility care" (2026 cost layers, 100-day limit, eligibility, covered services)
CMS.gov: "2026 Medicare Parts A & B Premiums and Deductibles" (November 14, 2025)
Medicare.gov: "Costs" (2026 Part A SNF stay amounts and benefit-period deductible)
CMS.gov: "Skilled Nursing Facility Billing Reference" (MLN006846)
Medicare.gov: "Nursing home care" (custodial care not covered if it is the only care you need)
Medicare.gov: "Long-term care" (Medicare does not pay for long-term / custodial care)
Medicare.gov: "Medicare Coverage of Skilled Nursing Facility Care" (CMS Product No. 10153)
Medicare.gov: "Inpatient or outpatient hospital status affects your costs"
NCDOI: "Medicare and Seniors' Health Insurance Information Program (SHIIP)"
Medicare.gov: "Learn what Medigap Covers"
Medicare.gov: "Skilled Nursing Facilities"