Medicare Skilled Nursing 100-Day Coverage Gap Explained
September 24, 2026
The Skilled Nursing Facility Coverage Gap Starts on Day 101
Medicare Part A pays for skilled nursing facility (SNF) care, short-term rehabilitation after a hospital stay, for up to 100 days in a single benefit period. Coverage narrows well before that cutoff: Original Medicare pays the full cost for the first 20 days, requires a daily coinsurance payment for days 21 through 100, and pays nothing toward the stay once day 101 arrives. That last point is often called the 100-day skilled nursing coverage gap, and it catches many families off guard because it can hit while a patient still needs daily skilled care.
Knowing exactly where the gap starts, and what can fill it, helps you plan before a hospital discharge turns into an unexpected bill.
Quick Answer
Medicare Part A covers skilled nursing facility care in full for days 1 through 20 of a benefit period, then requires a daily coinsurance for days 21 through 100. After day 100, Original Medicare pays $0 toward that stay, creating a coverage gap. A Medigap policy can help with the days 21-100 coinsurance but not with care after day 100. Medicaid, long-term care insurance, or private funds are the main ways to pay once Medicare's SNF benefit runs out.
How Medicare Splits the 100 Days
According to the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, a SNF benefit period breaks into three cost stages. Days 1 through 20 are covered at no cost to you. Days 21 through 100 require a set daily coinsurance amount that Medicare.gov updates every year, in 2025 that amount was $209.50 per day, so confirm the current figure before budgeting since it changes annually. From day 101 forward, Medicare pays nothing and you're responsible for the full daily rate.
SNF Costs by Day Range in a Benefit Period
| Feature | You Pay | Medicare Pays |
|---|---|---|
| Days 1-20 | $0 | Full cost |
| Days 21-100 | Daily coinsurance, set annually by CMS | Remaining cost |
| Day 101 and beyond | Full cost | $0 |
Benefit Periods Reset After 60 Days Out of Care
A Medicare benefit period ends once you've gone 60 days in a row without inpatient hospital or SNF care. If a new benefit period starts, you become eligible for up to 100 new SNF days, but per Medicare.gov you must again meet the qualifying hospital stay rule. Simply staying in the same facility without a break does not reset the count.
Why the Benefit Is Capped at 100 Days
Medicare's SNF benefit generally requires a prior inpatient hospital stay of at least three consecutive days, plus a doctor's order for daily skilled nursing or therapy related to that hospitalization. Some Medicare Advantage plans waive the three-day stay rule, though the 100-day limit still applies because federal law requires Medicare Advantage plans to cover at least what Original Medicare covers.
The 100-day limit exists because this benefit is built for short-term rehabilitation, not long-term custodial care such as help with bathing, dressing, or eating that doesn't require a skilled professional. Once a patient's needs shift from skilled recovery to ongoing custodial support, or once the 100 days run out, Original Medicare stops paying regardless of how much daily care is still needed. This is one of several Medicare coverage gaps that surprise families who assume nursing home stays are covered indefinitely.
What Pays for Care After Day 100
Once Medicare stops paying on day 101, a few sources typically fill the gap. A Medigap policy, sold through private insurers to work alongside Original Medicare, can cover part or all of the days 21-100 coinsurance depending on the plan letter, but no Medigap plan extends SNF coverage past day 100 because there's no underlying Medicare benefit left to supplement. Compare how these plans price out in our guide to Medicare Supplement premiums by age.
Medicaid, the joint federal-state program for people with limited income and assets, can cover long-term nursing home care for those who qualify, and many people spend down savings to become eligible. Learn how the two programs interact in our guide to Medicare and Medicaid, and see whether a dual-eligible special needs plan fits your situation if you already qualify for both programs. Veterans may also have separate nursing home benefits through the VA; check how those coordinate with Medicare in our guide to Medicare and veterans benefits. Long-term care insurance, a separate policy purchased in advance, is the remaining option for people who want coverage beyond what Medicare and Medicaid provide.
Action Checklist Before Day 100
- Ask the SNF discharge planner for your exact day count and benefit period start date
- Request a written Notice of Medicare Non-Coverage before benefits end
- Check whether your Medigap policy covers the days 21-100 coinsurance
- Ask a hospital or SNF social worker about Medicaid spend-down rules in your state
- Compare long-term care insurance or private-pay costs if care will continue past day 100
Get free guidance on Medicare coverage gaps
If you're weighing Medigap, Medicare Advantage, or Medicaid options to help cover skilled nursing costs, get plain-language help matching coverage to your situation. No pressure.
Frequently Asked Questions
Yes. Federal law requires Medicare Advantage plans to cover at least what Original Medicare covers, so SNF benefits are capped at 100 days per benefit period. Some Medicare Advantage plans also require prior authorization or use different network rules, so check your specific plan's terms before a stay.
Most Medigap plans, including Plans C, D, F, G, K, L, M, and N, cover all or part of the SNF coinsurance for days 21 through 100 depending on the plan letter, according to Medicare.gov. No Medigap plan pays for SNF care after day 100, because Original Medicare provides no benefit at that point to supplement.
No. A new 100-day benefit becomes available only after a new benefit period starts, which requires 60 consecutive days without inpatient hospital or SNF care. Remaining in the same facility without that break does not reset the day count.
Medicaid can cover long-term nursing home stays for people who meet their state's income and asset limits, unlike Medicare's short-term SNF benefit. Coverage details, income limits, and spend-down rules vary by state, so confirm specifics with your state Medicaid agency.