Does Medicare Part B Cover a Skilled Nursing Facility? (w/Examples) + FAQs

Yes, Medicare Part B does cover certain services inside a skilled nursing facility — but it does not cover the SNF stay itself. That job belongs to Medicare Part A, which pays for the room, meals, nursing care, and therapies during a qualifying inpatient stay. Part B steps in to cover outpatient-level services like doctor visits, diagnostic tests, and therapy when Part A coverage doesn’t apply or has run out.

Under 42 U.S.C. § 1395d(a)(2), Medicare Part A limits SNF coverage to 100 days per benefit period — and only after a qualifying 3-day inpatient hospital stay. Once those 100 days end, or if the beneficiary never qualified for Part A in the first place, Part B becomes the only Medicare coverage option for services received inside the facility. Nearly 2.5 million Medicare beneficiaries enter skilled nursing facilities each year, and many have no idea Part A and Part B play different roles in the same building.

Here’s what you’ll learn in this article:

🏥 The exact services Part B covers inside a skilled nursing facility — and what it will never pay for
💰 How much you’ll pay out of pocket under Part B vs. Part A in 2026, including deductibles and coinsurance
⚠️ Why the 3-day hospital stay rule disqualifies thousands of people from Part A coverage every year — and what Part B can still do for them
📋 Step-by-step instructions for appealing a Medicare SNF coverage denial at all five levels
🔄 How Medicare Advantage plans handle SNF coverage differently, including the power to waive the 3-day rule

What Medicare Part A Actually Covers in a Skilled Nursing Facility

Medicare Part A is the primary payer for skilled nursing facility stays. It covers the room, meals, skilled nursing care, physical therapy, occupational therapy, speech therapy, medications, and medical supplies — all bundled into one payment to the facility. This bundled payment is called the Prospective Payment System (PPS), and it means the SNF cannot bill Part B separately for these services while the patient is under Part A coverage.

Part A coverage kicks in only when four strict requirements are met. The beneficiary must have Part A, must have completed a qualifying 3-day inpatient hospital stay, must enter the SNF within 30 days of hospital discharge, and must need daily skilled nursing or rehabilitation services. Missing even one of these requirements means Part A will not pay a single dollar toward the SNF stay.

How Part A Breaks Down the 100-Day Benefit Period

The cost-sharing structure shifts dramatically depending on which day of the stay the beneficiary is on. The 2026 rates set by CMS create three distinct cost tiers within a single benefit period.

Day of SNF Stay	What You Pay in 2026
Days 1–20	$0 — Medicare Part A covers 100%
Days 21–100	$217.00 per day coinsurance
Days 101+	All costs — Part A coverage exhausted

A benefit period begins the day you’re admitted as a hospital inpatient and ends after 60 consecutive days without receiving skilled nursing or inpatient hospital care. If you re-enter a hospital and then an SNF after the benefit period resets, you get a fresh 100 days. The Part A deductible of $1,736 in 2026 must be paid at the start of each new benefit period for the hospital stay, but it does not apply again separately for the SNF admission within the same benefit period.

What Medicare Part B Covers Inside a Skilled Nursing Facility

Medicare Part B covers outpatient-type services provided inside a skilled nursing facility. These services are billed individually using CPT and HCPCS codes, unlike the bundled Part A payment. Part B applies whenever a resident is either not under a qualifying Part A stay or has exhausted the 100-day Part A benefit.

The Center for Medicare Advocacy lists the following Part B services that can be delivered in an SNF setting:

Physician and practitioner visits — doctor consultations, nurse practitioner evaluations, and specialist appointments conducted at the bedside or in the facility
Outpatient physical, occupational, and speech therapy — covered at 80% of the Medicare-approved amount after the Part B deductible is met
Diagnostic tests — lab work, X-rays, MRIs, and other imaging ordered by the treating physician
Durable medical equipment (DME) — wheelchairs, walkers, hospital beds, and oxygen equipment prescribed for the resident
Ambulance services — medically necessary transportation to and from the facility
Mental health services — psychiatric evaluations and counseling sessions
Preventive services — flu shots, wellness visits, and cancer screenings

The 2026 Part B Cost Structure for SNF Residents

After meeting the $283 annual Part B deductible in 2026, the beneficiary pays 20% coinsurance on all Medicare-approved amounts for covered services. Medicare pays the remaining 80%. The standard Part B monthly premium is $202.90 in 2026. These costs apply whether the beneficiary receives Part B services at home, in a doctor’s office, or inside a skilled nursing facility.

Part B Cost Component (2026)	Amount
Monthly premium	$202.90
Annual deductible	$283
Coinsurance after deductible	20% of Medicare-approved amount

The Critical Difference Between Part A and Part B in an SNF

The confusion between Part A and Part B inside a skilled nursing facility causes real financial harm. Part A covers the entire stay — room, board, nursing, therapy — as one package. Part B covers only individual outpatient services and will never pay for the room or meals.

Feature	Part A SNF Coverage	Part B SNF Coverage
Covers room and board	Yes	No
Requires 3-day hospital stay	Yes	No
Maximum coverage period	100 days per benefit period	No day limit
Payment method	Bundled (one payment to SNF)	Fee-for-service (each service billed separately)
Therapy coverage	Included in bundle	80% of approved amount after deductible
Physician visits	Included in bundle	80% of approved amount after deductible

When a Part A–covered stay ends — whether because the 100 days ran out or because Medicare determined skilled care was no longer needed — the beneficiary may still reside in the facility. At that point, Part B becomes the only source of Medicare coverage for any medical services received in the SNF. The resident becomes responsible for room and board out of pocket or through Medicaid, long-term care insurance, or personal funds.

The 3-Day Hospital Stay Rule and Why It Blocks Part A Coverage

Section 1861(i) of the Social Security Act requires a minimum 3 consecutive inpatient hospital days before Medicare Part A will cover an SNF stay. The discharge day does not count toward the three days. A patient admitted Monday and discharged Thursday has met the rule. A patient admitted Monday and discharged Wednesday has not.

Observation Status: The Hidden Trap

Observation status is classified as outpatient care, even if the patient spends multiple nights in a hospital bed. Time spent under observation does not count toward the 3-day inpatient requirement. Thousands of Medicare beneficiaries each year discover — often after entering an SNF — that their hospital stay was classified as observation rather than inpatient. The consequence is devastating: Part A pays nothing, and the patient faces the full cost of the SNF stay.

This is precisely where Part B matters most. Even when Part A coverage is blocked by the 3-day rule, Part B can still cover outpatient therapy, doctor visits, and diagnostic services delivered inside the SNF. It won’t pay for the room or nursing care, but it will cover medically necessary rehabilitation services.

The New TEAM Demonstration: A 3-Day Rule Waiver (2026–2030)

Starting January 1, 2026, CMS launched the Transforming Episode Accountability Model (TEAM), a mandatory demonstration that waives the 3-day hospital stay rule for beneficiaries undergoing one of five specific surgical procedures. Participating acute care hospitals can discharge patients directly to a qualified SNF without the 3-day stay, and Part A will still pay for the SNF care. This demonstration runs through December 31, 2030.

The SNF 3-Day Rule Waiver has also been available to certain Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program. Eligible ACOs can apply to waive the rule for their attributed beneficiaries, provided the beneficiary meets all other SNF coverage requirements.

Three Real-World Scenarios: Part A, Part B, and the Coverage Gap

Scenario 1: Margaret’s Part A Benefit Runs Out

Margaret, age 74, breaks her hip and is admitted to the hospital as an inpatient for 4 days. She transfers to a skilled nursing facility for rehabilitation. Part A covers everything for the first 20 days at $0 cost. From days 21 through 100, she pays $217 per day in coinsurance. On day 85, her physical therapist recommends continued therapy, but Margaret’s medical team determines she no longer needs daily skilled care. Medicare ends her Part A coverage.

What Happens	Coverage Result
Days 1–20 in SNF	Part A pays 100% — Margaret pays $0
Days 21–84 in SNF	Part A pays, Margaret pays $217/day coinsurance
Day 85+ (skilled care ends)	Part A stops — Part B covers outpatient therapy at 80% after $283 deductible
Room and board after day 85	Margaret pays out of pocket

Margaret continues receiving physical therapy three times per week under Part B. She pays 20% coinsurance on each session. Her room and board costs shift entirely to her personal funds.

Scenario 2: David’s Observation Status Blocks Part A

David, age 68, is rushed to the emergency room with severe pneumonia. He spends 3 nights in the hospital but is classified under observation status the entire time. His doctors recommend an SNF stay for IV antibiotics and respiratory therapy. David enters the SNF expecting Medicare to cover it.

What Happens	Coverage Result
Hospital stay (3 nights, observation)	Does not meet the 3-day inpatient rule
SNF room, board, and nursing care	Not covered by Part A or Part B
Doctor visits inside the SNF	Covered by Part B at 80% after deductible
Outpatient respiratory therapy	Covered by Part B at 80% after deductible
Diagnostic lab work and X-rays	Covered by Part B at 80% after deductible

David is responsible for all room and board costs. Part B saves him from paying full price for his medical services and therapy, but the SNF charges for custodial care come out of his own pocket.

Scenario 3: Linda Uses Medicare Advantage With a 3-Day Waiver

Linda, age 71, is enrolled in a Medicare Advantage (MA) plan that has waived the 3-day hospital stay rule. She undergoes outpatient knee replacement surgery and is discharged the same day. Her MA plan authorizes a direct transfer to an SNF for post-surgical rehabilitation without any inpatient hospital stay.

What Happens	Coverage Result
Outpatient surgery (no hospital admission)	3-day rule waived by MA plan
SNF room, board, nursing, therapy	Covered under MA plan’s SNF benefit
Copays and coinsurance	Determined by Linda’s specific MA plan
Duration of coverage	Set by MA plan, may differ from Original Medicare’s 100 days

Linda’s experience is fundamentally different from David’s because her MA plan exercised its legal authority to waive the 3-day rule. Her out-of-pocket costs depend entirely on her plan’s benefit structure, which may include daily copays that differ from Original Medicare’s coinsurance schedule.

How Medicare Advantage Handles SNF Coverage Differently

Medicare Advantage (Part C) plans are required by law to cover at least everything Original Medicare covers. Many MA plans go further by waiving the 3-day hospital stay rule entirely, allowing beneficiaries to enter an SNF directly after outpatient procedures or even without a hospital stay at all. Over 30% of Medicare beneficiaries are now enrolled in MA plans.

MA plans can also change the cost-sharing structure. Some plans charge $0 copay for the first 20 days (matching Original Medicare) but then impose a flat daily copay — sometimes lower than the $217/day Original Medicare coinsurance — for days 21 through 100. Other plans may charge daily copays starting on day 1, which Original Medicare does not do.

The Trade-Off: Network Restrictions

MA plans typically require the beneficiary to use in-network skilled nursing facilities. If the preferred SNF is not in the plan’s network, the beneficiary may face higher costs or outright denial. Original Medicare has no network restrictions — any Medicare-certified SNF in the country will accept Part A. This network limitation is the single biggest drawback of the MA approach to SNF coverage.

The Jimmo v. Sebelius Settlement: Maintenance Therapy Is Covered

A landmark legal settlement changed how Medicare covers therapy in skilled nursing facilities. In Jimmo v. Sebelius (No. 11-cv-17, D. Vt.), the court approved a settlement requiring Medicare to cover skilled therapy services for maintenance purposes — not just for improvement. Before this settlement, Medicare routinely denied coverage when a patient’s condition was not expected to improve.

The Jimmo settlement applies to both Part A and Part B therapy coverage. A beneficiary who needs skilled physical therapy to maintain current function or prevent deterioration — even if the condition will never get better — is entitled to coverage. The key requirement is that the services must be so complex that only a skilled therapist can safely perform or supervise them.

This ruling matters most for residents with chronic or degenerative conditions like Parkinson’s disease, multiple sclerosis, or stroke aftereffects. Without the Jimmo settlement, these residents would lose therapy coverage the moment a claims reviewer decided improvement was unlikely.

Mistakes to Avoid With Medicare SNF Coverage

These are the most common — and most expensive — errors beneficiaries and families make when dealing with skilled nursing facility coverage.

1. Assuming observation status counts as inpatient. Hospital observation is classified as outpatient care. Nights spent in the hospital under observation do not count toward the 3-day inpatient requirement. Always ask the hospital whether you’ve been admitted as an inpatient or placed under observation.

2. Waiting too long to enter the SNF. The beneficiary must enter the SNF within 30 days of hospital discharge. Missing this window by even one day disqualifies the entire Part A benefit for that stay. Calendar the 30-day deadline immediately upon discharge.

3. Confusing skilled care with custodial care. Medicare covers only skilled nursing and therapy services — care that requires the training and judgment of a licensed professional. Help with bathing, dressing, and eating (custodial care) is not covered by Part A or Part B. Many families assume Medicare will pay for long-term custodial stays and are shocked by bills exceeding $8,000 per month.

4. Not appealing a coverage denial. Medicare denials can be — and frequently are — overturned on appeal. Failing to appeal within the deadline forfeits the right to challenge the denial. The first-level appeal costs nothing and requires only a written explanation attached to the Medicare Summary Notice.

5. Ignoring the benefit period reset. A benefit period ends after 60 consecutive days without skilled nursing or hospital care. If a beneficiary returns to an SNF after a 60-day break, a new benefit period begins with a fresh 100 days — but also a new $1,736 Part A deductible. Planning the timing of SNF re-admissions around the benefit period can save thousands of dollars.

6. Believing Part B will cover room and board. Part B covers medical services inside the SNF. It does not pay for the room, meals, or nursing staff assistance with daily activities. After Part A ends, room and board become the patient’s financial responsibility.

Pros and Cons of Relying on Part B for SNF Services

Pros	Cons
No 3-day hospital stay required — Part B applies regardless of prior hospitalization	No room and board coverage — Part B never pays for lodging or meals in the SNF
No day limit — Part B has no 100-day cap like Part A	20% coinsurance adds up — therapy sessions, doctor visits, and tests all carry a 20% out-of-pocket cost
Therapy caps repealed — the Bipartisan Budget Act of 2018 eliminated annual limits on outpatient therapy spending	Annual deductible applies — the $283 deductible (2026) must be met before Part B pays anything
Maintenance therapy covered — the Jimmo settlement ensures coverage even without improvement potential	Each service billed separately — unlike Part A’s bundled payment, Part B creates multiple bills from multiple providers
Available to all Part B enrollees — no special eligibility beyond standard Part B enrollment	No skilled nursing coverage — Part B does not pay for 24-hour nursing supervision or skilled nursing care as a room-level service

How to Appeal a Medicare SNF Coverage Denial

Medicare provides five levels of appeal, and every beneficiary has the right to challenge a denial at each level. The National Council on Aging recommends filing promptly because strict deadlines apply at every stage.

Level 1: Redetermination

The first step is to circle the denied service on your Medicare Summary Notice (MSN) and fill out the appeal section at the bottom. Mail it to the Medicare Administrative Contractor (MAC) whose address appears on the MSN. You have 120 days from the MSN date to file. Include a letter from your doctor explaining why the service is medically necessary. The MAC must respond within 60 days.

Level 2: Reconsideration

If the MAC upholds the denial, you can request reconsideration from a Qualified Independent Contractor (QIC). This is a completely independent review by a different organization. The QIC reviews all medical records and may request additional documentation from the provider.

Level 3: Administrative Law Judge Hearing

A denial at Level 2 can be escalated to a hearing with an Administrative Law Judge (ALJ), but only if the amount in dispute meets a minimum threshold — $190 in 2025. The hearing is usually held by videoconference or teleconference.

Level 4: Medicare Appeals Council

If the ALJ rules against you, you can appeal to the Medicare Appeals Council, which conducts a paper review of the entire case record.

Level 5: Federal District Court

The final appeal goes to U.S. District Court, but the amount in controversy must be at least $1,900 in 2025. This is a formal judicial proceeding.

Fast Appeals for Active SNF Stays

If you’re currently in an SNF and receive a Notice of Medicare Non-Coverage (NOMNC), a faster process applies. You must call the Quality Improvement Organization (QIO) listed on the notice and request a fast appeal before the coverage end date. Also request the Detailed Explanation of Non-Coverage (DENC) from the facility the same day. The QIO decision comes within 72 hours — far faster than the standard 60-day timeline.

Do’s and Don’ts for Medicare SNF Coverage

Do’s:

Do confirm your hospital admission status (inpatient vs. observation) before discharge — this single fact determines whether Part A will cover your SNF stay
Do enter the SNF within 30 days of hospital discharge to preserve your Part A eligibility
Do request a written copy of the NOMNC and DENC immediately if told your coverage is ending
Do file every appeal within the deadline, even if you think the denial is final — overturned denials are common
Do ask your doctor to write a medical necessity letter supporting continued skilled care

Don’ts:

Don’t assume hospital nights equal inpatient days — observation status is outpatient
Don’t leave the SNF for more than 30 days during a benefit period unless you understand the coverage gap consequences
Don’t confuse Part B therapy coverage with Part A room-and-board coverage — they are completely separate
Don’t accept a verbal denial without a written notice — you need documentation to file an appeal
Don’t forget that the benefit period resets after 60 days without skilled care, triggering a new Part A deductible

Key Organizations and Their Roles

Several entities govern, administer, and advocate within the Medicare SNF coverage system. Understanding who does what can mean the difference between a paid claim and a denied one.

Centers for Medicare & Medicaid Services (CMS) sets the rules, payment rates, and coverage policies for all Medicare benefits, including the SNF Prospective Payment System. CMS also oversees the TEAM demonstration and the 3-Day Rule Waiver program.

Medicare Administrative Contractors (MACs) process and pay Medicare claims in assigned geographic regions. They make the initial coverage determinations and handle Level 1 appeals. The MAC’s name and address appear on every Medicare Summary Notice.

Quality Improvement Organizations (QIOs) handle fast appeals when a beneficiary is actively receiving care and receives a notice that coverage will end. They are the first point of contact for expedited reviews of SNF coverage terminations.

The Center for Medicare Advocacy is a nonprofit that provides free legal assistance and policy analysis. They were instrumental in the Jimmo v. Sebelius settlement and continue to push for expansion of SNF coverage rights.

Step-by-Step: What Happens When Part A Ends and Part B Begins

Understanding the exact sequence of events when Part A coverage stops inside an SNF prevents financial surprises.

Step 1: The SNF’s medical team determines that the resident no longer needs daily skilled nursing or daily skilled rehabilitation services. This can happen on any day — not just at the 100-day mark.

Step 2: The SNF issues a Notice of Medicare Non-Coverage (NOMNC) at least 2 days before the proposed end of Part A coverage. This notice must include the date coverage will stop and instructions for filing a fast appeal.

Step 3: If the resident does not appeal (or the appeal is denied), Part A coverage ends on the date stated in the NOMNC. The resident becomes responsible for all room and board costs starting that day.

Step 4: Any medically necessary outpatient services — therapy, doctor visits, lab work — shift to Part B billing. The SNF and external providers begin billing these services individually. The resident pays 20% coinsurance after the $283 annual deductible.

Step 5: The resident and family must decide whether to remain in the facility as a private-pay or Medicaid resident, transfer to a lower-cost facility, or return home with outpatient or home health services.

FAQs

Does Medicare Part B pay for room and board in a skilled nursing facility?

No. Part B covers only outpatient medical services like therapy, doctor visits, and diagnostic tests inside an SNF — never room, meals, or custodial nursing care.

Can I receive Part B therapy in an SNF without a hospital stay?

Yes. Part B does not require any prior hospitalization. You can receive outpatient therapy in an SNF as long as the services are medically necessary and ordered by a physician.

Is there a limit on how much Part B therapy Medicare will cover?

No. The Bipartisan Budget Act of 2018 permanently repealed the therapy caps. There is no annual dollar limit on Part B outpatient therapy services.

Does observation status count toward the 3-day hospital stay rule?

No. Observation is classified as outpatient care and does not count toward the 3 consecutive inpatient days required for Part A SNF coverage.

Can Medicare Advantage plans waive the 3-day hospital stay requirement?

Yes. Medicare Advantage plans are permitted by law to waive the 3-day rule, allowing direct SNF admission without a qualifying inpatient hospital stay.

Does Medicare cover SNF care if my condition won’t improve?

Yes. The Jimmo v. Sebelius settlement requires Medicare to cover skilled maintenance therapy even when improvement is not expected, as long as skilled services are needed.

How long do I have to appeal a Medicare SNF coverage denial?

120 days. You must file a Level 1 redetermination with the Medicare Administrative Contractor within 120 days of the date on your Medicare Summary Notice.

Can an SNF bill both Part A and Part B for the same patient on the same day?

No. An SNF cannot bill both parts for the same service date. Only one part applies based on the patient’s current coverage status and eligibility.

What happens if I leave the SNF for more than 60 days?

Your benefit period ends. A new benefit period starts if you are readmitted, giving you a fresh 100 days but also requiring a new Part A deductible of $1,736 in 2026.

Does Part B cover telehealth services inside a skilled nursing facility?

Yes. Under certain conditions, Medicare Part B may cover telehealth services provided to residents in skilled nursing facilities, including mental health consultations and physician follow-ups.

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