Medicare Part A covers skilled nursing facility care for up to 100 days per benefit period following a qualifying hospital stay. Days 1-20: Medicare pays 100%. Days 21-100: Medicare pays after a daily co-insurance of approximately $200/day (2026 rate). After day 100: Medicare coverage ends entirely. Coverage can end earlier if the patient no longer meets the criteria for skilled care.

Medicare requires a minimum three-night inpatient hospital stay — not just three nights in a hospital bed — before it will cover a SNF stay. If your loved one was admitted under “observation status” rather than as an inpatient, those nights do not count toward the three-night requirement. This is a critical and frequently misunderstood distinction. Always ask the hospital whether your loved one is admitted as an inpatient or under observation status.

Medicare coverage can end before day 100 if a skilled care need is no longer present — meaning the patient no longer requires skilled nursing or therapy services for a condition that is expected to improve. Medicare cannot end coverage solely because the patient is no longer improving, though this misconception is widespread. Patients and families have the right to appeal coverage termination to the BFCC-QIO.

Options when Medicare coverage ends: (1) private pay — continue at the SNF at the full daily rate (typically $250-$350/day in Texas); (2) transition to Medicaid if the patient is financially and medically eligible for Medicaid nursing home coverage; (3) discharge to assisted living, which is typically less expensive than SNF private pay; (4) discharge home with home health and caregiver support; (5) long-term care insurance if applicable.

Private pay SNF rates in Texas typically range from $250 to $350+ per day for a semi-private room — approximately $7,500 to $10,500 per month. Private room rates are higher. These rates reflect the 24-hour nursing care, therapy services, meals, and medical management provided. This is significantly more expensive than assisted living for patients who no longer require skilled nursing care.

If your parent no longer requires skilled nursing care — meaning they are medically stable and their care needs are primarily custodial (assistance with daily activities) rather than medical — assisted living is typically more appropriate, more homelike, and considerably less expensive than continuing in a SNF on private pay. A placement agent can help identify assisted living options that match your parent’s remaining care needs and your budget.

With adequate planning, the transition can be arranged in five to seven days. In urgent situations (Medicare ending imminently), a placement can sometimes be arranged in 24 to 48 hours. The key is starting the process early — as soon as the therapists begin discussing discharge planning, start exploring assisted living options. Waiting until the last day of coverage creates avoidable pressure and may result in suboptimal placements.

Ideally, start the day your parent is admitted. At admission, ask: how long is Medicare coverage expected to last? What are the discharge criteria? What level of care will be needed when skilled care ends? This allows two to three weeks of planning rather than two to three days. Contact a placement agent in the first week of a SNF stay to begin identifying post-Medicare options.

A SNF cannot hold a patient against their will (or against the will of their healthcare decision-maker) unless the discharge would create imminent danger and a protective order is involved. If a patient or family wants to discharge, the SNF must provide written notice and facilitate the transition. If you believe a SNF is inappropriately preventing discharge, contact the Texas Long-Term Care Ombudsman immediately.

If a patient may qualify for Medicaid and will need long-term SNF care, applying for Medicaid before coverage ends is important. Once an application is filed, the patient is in “Medicaid pending” status — some SNFs will continue to provide care during the pending period rather than require immediate private pay, with the understanding that Medicaid will cover retroactively once approved. Confirm the SNF’s policy on this before relying on it.

Medicare Advantage plans (Part C) have their own SNF coverage rules, which may differ significantly from traditional Medicare. Some Advantage plans offer more generous SNF coverage (beyond 100 days) or have lower co-insurance. Others have stricter criteria for continued coverage. Always review your specific Advantage plan’s SNF coverage rules when a skilled nursing stay begins — do not assume it mirrors traditional Medicare.

A patient can be readmitted to a SNF after discharge if they have a new qualifying hospital stay (three inpatient nights) and again have a skilled care need. If the readmission occurs within 60 days of the same benefit period, the remaining days from the original 100-day benefit may apply. After 60 days of not receiving SNF care, a new benefit period begins, resetting the 100-day clock. This has important implications for planning readmission coverage.