Medicare Stops Paying When Rehab Ends. Who Pays for the Nursing Home Now?

Original Medicare Part A covers a skilled nursing facility stay only when all of these are true: your parent was admitted to the hospital as an inpatient for at least three days in a row (the discharge day doesn't count), entered a Medicare-certified facility generally within 30 days of leaving the hospital, and needs daily skilled nursing or therapy for a condition treated in the hospital.

Don't plan around 100 days. That is the most Medicare will ever pay, not what it usually pays. In practice, coverage ends as soon as your parent no longer needs daily skilled care, often 10 to 30 days after arriving, and the family may hear about it with only two days' notice.

Watch for "observation status." Time in the emergency room or under observation does not count toward the three inpatient days. If the hospital kept your parent "under observation" rather than admitting them, Medicare may not cover the rehab stay at all. Ask the hospital directly how your parent is classified.

The facility decides when it believes your parent no longer needs daily skilled care. Before Medicare coverage ends, it must give you a written Notice of Medicare Non-Coverage, at least two days before the last covered day.

If you disagree, you can ask for a fast appeal. Call the number on the notice, which reaches an independent reviewer called the BFCC-QIO, no later than noon on the day before the date coverage ends. Your parent can stay while the reviewer decides. If you miss that deadline, you can still appeal, but Medicare pays for the extra days only if the decision goes your way.

A fast appeal buys time. It rarely changes the long-term picture, because Medicare was never designed to pay for someone who needs help with daily living but no longer needs rehab. That is custodial care, and Medicare doesn't cover it.

A Medicare supplement can pay the $217 daily coinsurance that starts on day 21, so check the policy before assuming the family owes it. Most standardized plans pay it in full, including Plan G and Plan N, the two most commonly sold today. Plan K pays half and Plan L pays 75%. Plans A and B don't pay it.

A supplement only fills gaps in days Medicare is already covering. When Medicare stops because rehab is over, the supplement stops on the same day. No Medigap plan pays for long-term custodial care.

Find the policy, or call the insurer, and ask two questions: which plan letter it is, and whether it pays skilled nursing facility coinsurance. Older policies sold before the current lettered plans, and some long-term care riders, can work differently.

Medicare Advantage plans must cover skilled nursing care, but they set their own terms. Many waive the three-day hospital stay. Some charge a daily copay during the first 20 days, and plans usually require advance approval of the stay and keep re-approving it.

The plan, not the facility, usually decides when coverage stops. You still get a Notice of Medicare Non-Coverage, and you can still ask for a fast review. Call the plan the day your parent is admitted, ask what the copays are and how often the stay is reviewed, and write down the name of the person you spoke with.

For long-term nursing home care, Florida Medicaid's Institutional Care Program (ICP) is what most families end up relying on. It covers the nursing home's daily rate once your parent qualifies medically and financially.

Two points surprise most families:

1. Income over the limit doesn't disqualify your parent. If gross monthly income is above $2,982, Florida requires a Qualified Income Trust (sometimes called a Miller trust) to hold the excess. A QIT is a legal document and must be prepared by an attorney.
2. Your parent still pays something each month. Once approved, most of your parent's income goes to the nursing home as their "patient responsibility." Medicaid pays the rest. Your parent keeps the $160 allowance and money for health insurance premiums.

The home, one car, and certain other assets usually don't count toward the $2,000 limit, and a spouse living at home can keep considerably more. Those rules are where planning matters, and they are the work of an elder law attorney.

For most adults, Florida Medicaid coverage starts no earlier than the first day of the month you apply. It does not reach back to cover the months before. Every month the application waits is a month the family may owe privately, and a month of nursing home care costs thousands of dollars.

The gap between Medicare and Medicaid usually opens like this:

1. Your parent enters rehab under Medicare.
2. Around week two or three, therapy progress slows and the facility issues a Notice of Medicare Non-Coverage.
3. The family learns the Medicaid application takes weeks to assemble, and DCF often needs several more weeks to decide.
4. In the meantime, the facility lists your parent as "Medicaid pending" and bills privately, or asks the family to pay.

The fix is to start the Medicaid application during the Medicare days, not after them. If your parent may qualify for Medicaid while still in the Medicare period, Medicaid can also help with the $217 daily coinsurance starting on day 21.

• Ask the hospital or facility whether your parent was admitted as an inpatient or kept under observation.
• Find out whether your parent has Original Medicare or a Medicare Advantage plan. Call the plan if it's Advantage; if it's Original Medicare, find any Medigap policy and check its plan letter.
• Ask the facility's business office how long they expect Medicare to cover the stay.
• Read any Notice of Medicare Non-Coverage the day you receive it, and note the appeal deadline.
• Confirm who holds financial power of attorney. If no one does, call an elder law attorney now, because a Medicaid application and a QIT may need someone with legal authority to sign.
• Gather recent statements for every bank, investment, and retirement account, plus income letters for Social Security and pensions.
• Start the Medicaid application while your parent is still in the Medicare days.

How Senior Care Resources helps. We prepare and manage the Florida Medicaid application for a published flat fee, starting with a free assessment. If your parent needs a Qualified Income Trust, an appeal, or other legal work, that is handled by Zacharia Frey PLLC under a separate engagement, or by any elder law attorney you choose. Start your free Medicaid assessment or call (239) 977-5175.

• Medicare.gov, Skilled nursing facility care
• Medicare.gov, Fast appeals
• CMS MLN Matters MM14279, Medicare deductible, coinsurance and premium rates for CY 2026
• Medicare.gov, Compare Medigap plan benefits
• Fla. Admin. Code R. 65A-1.716, Income and Resource Criteria
• Florida Health Justice, 2026 SSI-related Medicaid standards (DCF Appendix A-9, April 2026)
• WUSF, Medicaid retroactive eligibility plan approved (June 2019)