Does Medicare Cover Skilled Nursing Care?

Medicare does cover skilled nursing facility care, but only under specific conditions and for a limited time. For families in Pasadena navigating a hospital discharge or a sudden change in a loved one’s health, understanding exactly what Medicare pays, when it applies, and where it stops is one of the most practical things you can do right now. This page breaks down the rules plainly so you can plan without surprises.

What Medicare Part A Covers in a Skilled Nursing Facility

Medicare Part A is the coverage that applies to skilled nursing facility stays. It is not automatic, and it does not cover every stay. Three conditions must all be true before Part A will pay anything toward a skilled nursing facility.

First, your loved one must have had a qualifying hospital stay. That means at least three consecutive days as a formal inpatient, not under observation status. Observation stays are billed under Part B and do not count toward the three-day requirement, even if your loved one slept in a hospital bed for several nights. This distinction trips up many families and results in unexpected bills.

Second, the skilled nursing facility must be Medicare-certified. Not every nursing home holds this certification. Confirming certification before admission is a step worth taking.

Third, the care needed must be skilled. Medicare defines skilled care as services that require the professional judgment of a licensed nurse or therapist, such as wound care, intravenous therapy, physical therapy following a stroke or surgery, or respiratory therapy. Custodial care, meaning help with bathing, dressing, and daily routines, does not qualify as skilled care under Medicare rules.

How Long Medicare Pays and What It Costs

According to Medicare.gov, Part A covers up to 100 days per benefit period in a Medicare-certified skilled nursing facility, but the cost structure changes significantly after the first 20 days.

• Days 1 through 20: Medicare pays 100 percent of covered costs. Your loved one pays nothing for this period if all eligibility conditions are met.
• Days 21 through 100: A daily coinsurance amount applies. In 2025, the coinsurance is $204.00 per day. A Medicare supplement plan (Medigap) may cover some or all of this coinsurance, depending on the plan.
• Day 101 and beyond: Medicare coverage ends. At this point, your family is responsible for the full daily cost unless Medi-Cal coverage applies or private long-term care insurance is in place.

The average length of a short-term skilled nursing stay is between 20 and 30 days, according to data from the Kaiser Family Foundation. Many stays fall within the fully covered window, but conditions requiring longer rehabilitation, such as hip replacement recovery or post-stroke therapy, often extend into the coinsurance period.

What Medicare Does Not Cover in a Nursing Home

Medicare was not designed to pay for long-term custodial care. Families sometimes discover this only after a loved one has been in a facility for several weeks and the bills begin arriving. The following are explicitly not covered by Medicare Part A in a skilled nursing facility:

• Custodial care, once skilled needs have been met, even if the person cannot safely return home
• Room and board once skilled care ends
• Personal care items
• Private room upgrades unless medically required
• Most dental, vision, and hearing services

When skilled care ends, the facility is required to provide written notice at least two days in advance. That notice is called a Notice of Medicare Non-Coverage. Families have the right to appeal this decision through the Beneficiary and Family Centered Care Quality Improvement Organization, known as BFCC-QIO, and a decision typically comes within one business day.

Does Medi-Cal Cover Skilled Nursing Care in California?

For California residents who meet income and asset requirements, Medi-Cal can cover skilled nursing facility care beyond the 100-day Medicare limit, including long-term residential stays. Medi-Cal is California’s Medicaid program and is administered through the California Department of Health Care Services.

Medi-Cal eligibility for nursing home care is based on both medical need and financial qualification. In 2025, an individual applying for Medi-Cal long-term care benefits may retain no more than $2,000 in countable assets, though a primary residence, one vehicle, and certain personal property are generally exempt. Spousal protections also apply when a community spouse remains at home.

The Medi-Cal application process for nursing home placement can take time, and families who anticipate needing long-term coverage should begin the process as early as possible. A social worker at the facility, or the Los Angeles County Department of Public Social Services, can assist with applications.

Pasadena Nursing Center accepts both Medicare and Medi-Cal. If your loved one is transitioning from a hospital stay and you are unsure about coverage, the admissions team can walk through eligibility and help coordinate with your loved one’s discharge planner.

What Happens When Medicare Coverage Ends

This is the question families ask most often, and the honest answer is that it depends on your loved one’s situation. Several options exist when the 100-day Medicare benefit period closes.

If your loved one qualifies for Medi-Cal, the transition to Medi-Cal coverage can happen within the same facility without a change in placement, provided the facility is Medi-Cal certified. Pasadena Nursing Center holds both Medicare and Medi-Cal certification.

If your loved one has a Medicare supplement plan, also called Medigap, review the policy carefully. Some plans cover the coinsurance for days 21 through 100 but do not extend coverage past day 100.

If private pay is required, skilled nursing facilities in the Pasadena area typically range from $350 to $500 per day, depending on the level of care, room type, and services required.

For families who believe Medicare ended coverage too soon, an appeal is always an option. The BFCC-QIO for California is Livanta LLC, and requests for a fast appeal must be submitted no later than noon the day before coverage is scheduled to end.

How to Confirm Medicare Eligibility Before Admission

Before your loved one is discharged from the hospital, the hospital’s case manager or social worker should confirm Medicare eligibility for a skilled nursing facility stay. Ask specifically whether your loved one has been admitted as an inpatient or placed under observation status. If observation status was used for any portion of the stay, clarify whether the three-day inpatient requirement has been met.

Once at the skilled nursing facility, the Medicare certification of that facility can be verified directly through Medicare’s Care Compare tool at medicare.gov/care-compare. This tool also shows inspection results, staffing levels, and quality ratings for certified facilities.

For families in Pasadena considering placement for a loved one who requires ongoing nursing oversight after a hospitalization, skilled nursing care at a Medicare-certified facility gives your loved one access to licensed nursing, rehabilitation therapy, and medical supervision under one roof during the critical recovery window.

Frequently Asked Questions About Medicare and Skilled Nursing Coverage

Talk to Someone Who Knows This Process

At Pasadena Nursing Center, families navigating Medicare and Medi-Cal questions are not left to figure it out alone. The admissions team at 1570 N Fair Oaks Ave works with hospital discharge planners across the San Gabriel Valley and can clarify coverage, confirm eligibility, and help coordinate a smooth transition from hospital to care. If your loved one is approaching discharge and you need answers quickly, call the team directly.

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Pasadena Nursing Center serves families from Pasadena, Arcadia, Monrovia, Temple City, San Marino, Alhambra, and Sierra Madre.