When a Rehab Stay Crosses Into a New Insurance Plan Year
A rehabilitation stay can begin in December and continue into January.
For Medicare Advantage or other Medicare health plans, that can matter because plan premiums, copays, provider networks, authorization rules, and benefits may change for the new plan year.
Do not assume an arrangement confirmed in December automatically continues unchanged on January 1.
Read the Annual Notice of Change
Medicare says plans send an Annual Notice of Change (ANOC) in the fall describing changes in coverage, costs, and more that take effect in January.
Review sections on:
- skilled nursing facility cost sharing;
- provider network;
- prior authorization;
- therapy;
- drugs;
- out-of-pocket maximum;
- supplemental benefits; and
- service-area changes.
Recheck the nursing facility
Ask:
“Will this facility remain in network for my exact plan on January 1?”
A provider can be in network one year and not the next.
Ask the plan and facility.
Recheck authorization
If the resident is already in an authorized course of treatment, ask:
- Does the authorization cross into the new year?
- Does a new authorization number apply?
- Is a continued-stay review required?
- Did the plan change utilization rules?
- What protections apply to ongoing treatment?
Do not assume prior authorization restarts or continues without confirmation.
Recheck member cost
Ask the plan to explain the member responsibility before and after January 1.
The Medicare Advantage plan’s cost structure can change once per year for the plan year.
Recheck drug coverage if the resident leaves the Part A covered period
If the resident moves from a Part A-covered SNF stay into long-term residence or home, Part D formulary/network changes can become important.
Plan-year transition card
Current plan: ____________________
Stay began: ____________________
January 1 still inpatient/SNF?: ____________________
Facility in network new year: ____________________
Authorization carries over: ____________________
New copay/coinsurance: ____________________
Drug changes: ____________________
ANOC reviewed: Yes / No
Plan reference: ____________________
Frequently asked questions
Does Original Medicare reset SNF days January 1?
No. Original Medicare SNF days follow benefit periods, not calendar years.
Can a Medicare Advantage plan change costs January 1?
Yes. Annual plan terms can change; review the ANOC/Evidence of Coverage.
Should we change plans in the middle of rehab?
That is an individualized coverage decision. Review enrollment rights and continuity implications with Medicare/SHIP before changing.
The practical goal
When a stay crosses January 1, treat the new plan year as a coverage verification checkpoint.
Reconfirm network, authorization, member cost, and any rule that affects the ongoing stay.
Related NHP guides
- Medicare Advantage vs Original Medicare for Rehab
- How to Verify a Nursing Home Is In Network for Your Exact Medicare Advantage Plan
Primary sources checked
*Editorial/source review: October 15, 2026. General education only. Home-health scope, ambulance coverage, annual plan changes, enrollment rights, and accessible-notice deadlines should be confirmed from current Medicare/plan materials.*
