A stay in a skilled nursing facility, often called a rehab stay, is not automatically covered by Medicare Part A. One important requirement is a qualifying inpatient hospital stay of at least 3 days in a row.
What counts toward the 3-day rule?
The hospital must formally admit you as an inpatient. Time spent in the emergency room or under observation generally does not count, even if you stay overnight. The day you leave the hospital does not count as one of the three inpatient days.
Other requirements also apply
You generally must enter a Medicare-certified skilled nursing facility within a short time, usually 30 days, and need skilled care related to the condition treated during your qualifying hospital stay. The facility and your care must meet Medicare’s coverage rules.
There can be exceptions. For example, some Accountable Care Organizations and other approved initiatives may waive the 3-day minimum. Ask the hospital’s utilization staff, your doctor, and the facility to explain your status before transfer.
Questions to ask
- Was I admitted as an inpatient, or was I under observation?
- How many qualifying inpatient days are recorded?
- Is the facility Medicare-certified?
- What skilled services are planned, and what will I owe?
Read the current requirements on Medicare.gov. This article is educational information, not a guarantee of coverage or payment.