The physical therapist just told your dad he’s made great progress. He can walk with a walker now, dress himself, and manage most daily activities. The stroke rehabilitation worked.
Then the nursing home’s billing department calls to schedule a meeting. They need to discuss payment now that Medicare’s coverage period is ending.
You’re confused. Dad still needs help. He can’t live alone yet. Isn’t Medicare supposed to cover this until he’s ready to go home?
The answer will determine whether your family pays nothing or over $13,000 per month for continued care.
Medicare Stops Paying When Rehab Ends
Medicare does not pay for nursing home care after rehabilitation ends.
This distinction catches thousands of families unprepared every year. Medicare Part A covers short-term skilled nursing facility stays for rehabilitation after hospitalization.
According to Centers for Medicare & Medicaid Services (CMS) guidelines, Medicare only covers care that requires skilled nursing or rehabilitation services.
When someone needs help with bathing, dressing, eating, or other daily activities but no longer requires skilled medical services, Medicare considers this “custodial care“—and Medicare doesn’t cover custodial care.
Medicare’s Strict Requirements for Skilled Nursing Facility Coverage
Medicare will pay for nursing home care only when all these conditions are met, according to 42 CFR § 409.31:
Three-day hospital stay: Your loved one must have an inpatient hospital stay of at least three consecutive days (not counting the discharge day).
Admission within 30 days: They must be admitted to the skilled nursing facility within 30 days of leaving the hospital.
Doctor certification: A physician must certify that skilled nursing or rehabilitation services are medically necessary.
Daily skilled care: The person must require skilled nursing or rehabilitation services every day. Medicare doesn’t cover custodial care (help with activities of daily living like bathing, dressing, or eating).
If any of these conditions aren’t met, Medicare won’t cover the stay at all.
How Long Medicare Pays for Skilled Nursing
When Medicare does cover a skilled nursing facility stay, coverage is temporary and limited according to Medicare.gov:
Days 1-20: Medicare pays 100% of costs (if you meet all requirements)
Days 21-100: You pay a daily coinsurance amount; Medicare covers the rest. For reference, this coinsurance was $204 per day in 2025 and adjusts annually.
Day 101 and beyond: Medicare stops paying entirely
This 100-day maximum is per benefit period, not per year. A benefit period begins when you enter the hospital and ends when you’ve been out of both the hospital and SNF for 60 consecutive days.
Most People Don’t Get 100 Days of Coverage
While Medicare allows up to 100 days per benefit period, most people don’t receive anything close to full coverage.
Medicare stops paying when:
- You no longer need daily skilled nursing or rehabilitation
- You stop showing measurable improvement from therapy
- Your condition stabilizes
- A doctor determines that skilled services are no longer medically necessary
In practice, many people receive only 20-40 days of Medicare coverage before they’re reclassified as needing custodial care rather than skilled care.
Options After Medicare Coverage Ends
When Medicare stops covering nursing home costs, you have limited options:
Pay Privately
You can continue paying for the nursing home privately. At Florida’s average rates exceeding $13,000 monthly, this quickly depletes savings.
Move to a Different Care Setting
Some people return home with home health services. Others move to assisted living facilities, which typically cost $3,500 to $5,000 per month in Florida.
These transitions only work if the person’s care needs allow for a less intensive setting. If they need 24/7 skilled nursing, moving isn’t feasible.
Apply for Medicaid
Florida Medicaid covers long-term nursing home care for those who qualify financially.
This is where most families eventually turn. Medicaid becomes the solution when private payment exhausts savings and Medicare coverage has ended.
The Transition Strategy From Medicare to Medicaid
The smartest approach involves planning before Medicare coverage ends.
Start the Medicaid Application Early
Don’t wait until Medicare stops paying to begin exploring Medicaid. The application process takes time, and gathering required documentation can take weeks or months.
Starting the Medicaid application while still receiving Medicare coverage ensures a smoother transition and reduces or eliminates the gap in coverage.
Understand the Financial Documentation Required
Florida’s Department of Children and Families requires extensive financial documentation:
- Five years of bank statements for all accounts
- Property records and titles
- Investment and retirement account statements
- Documentation for any closed accounts
- Proof of income from all sources
- Records of any large transactions or transfers
Gathering this documentation takes time. Starting early prevents delays.
Work With an Elder Law Attorney
The transition from Medicare to Medicaid involves complex planning, especially if you have assets to protect or have made any transfers in the past five years.
Experienced elder law attorneys can:
- Evaluate your financial situation and identify asset protection strategies
- Ensure proper application preparation to avoid denials
- Address any transfer penalties or problematic transactions
- Maximize spousal protections for married couples
- Manage the application process efficiently
The cost of professional help is typically less than one month of private-pay nursing home costs.
Medicare Advantage Plans May Have Different Rules
If your loved one has a Medicare Advantage plan (also called Medicare Part C) instead of Original Medicare, coverage rules may differ slightly.
Medicare Advantage plans must provide at least the same coverage as Original Medicare according to CMS regulations, but they may:
- Have different authorization requirements
- Use different facilities in their network
- Have varying coinsurance amounts
- Require additional documentation
Review your specific plan’s benefits to understand exactly what’s covered.
Plan Ahead for When Medicare Coverage Ends
Most families don’t realize Medicare doesn’t cover long-term nursing home care until they’re facing the bill. By then, options are limited.
If your loved one is currently receiving Medicare-covered rehab in a nursing facility, start planning now for what happens when that coverage ends.
At Berg Bryant Elder Law Group, our Florida Board Certified Elder Law Attorneys help families transition from Medicare to Medicaid while protecting as many assets as possible. We’ve guided thousands of Northeast Florida families through this process.
We serve families in Jacksonville, Jacksonville Beach, Fernandina Beach, Callahan, St. Augustine, Ponte Vedra Beach, Orange Park, Fleming Island, and throughout Duval, Nassau, St. Johns, and Clay Counties.
Contact us today to discuss your situation and develop a plan before Medicare coverage ends.
Author Bio
Kellen Bryant, Esq.
Founder
Florida Bar Board Certified Elder Law Attorney, Kellen Bryant focuses his law practice on advising and helping caregivers with a particular focus on asset protection and preservation from long-term care costs, creditors, and predators. Kellen Bryant is AV Preeminent® Rated, meaning his attorney peers rated him at the highest level of professional excellence. Kellen Bryant was nominated and selected as a Super Lawyer, Rising Star: 2022.
