Caregiver helping an older woman with daily activities in a care facility

Medicare Skilled Nursing Copays: What Happens After Day 20?

ByNHP Specialist Care Team

Short answer: For a covered skilled nursing facility (SNF) stay under Original Medicare in 2026, you pay $0 per day for days 1–20 of the benefit period after the applicable Part A deductible. For days 21–100, the 2026 SNF coinsurance is $217 per day. Beginning with day 101, Original Medicare does not pay for the SNF stay.

Those numbers describe Medicare cost-sharing—not a promise that Medicare will cover 100 days. Coverage can end earlier if the stay no longer meets Medicare’s skilled-care requirements.

Original Medicare SNF costs in 2026

Medicare’s 2026 cost information lists:

  • Days 1–20: $0 per day for covered SNF services after the applicable Part A deductible.
  • Days 21–100: $217 per day in 2026.
  • Day 101 and beyond: the beneficiary pays all costs unless another payer applies.

If the Part A deductible was already paid for hospital care in the same benefit period, Medicare says it is not paid again just because the patient entered a SNF during that benefit period.

Day 20 is not an automatic discharge date

Nothing about reaching day 21 automatically means the patient must leave the SNF. It means Original Medicare cost-sharing changes if the stay is still covered. The patient may continue receiving covered skilled care through available benefit days while paying the required coinsurance or using other coverage that pays some or all of it.

Day 100 is a maximum, not guaranteed coverage

Medicare Part A can cover up to 100 SNF days in a benefit period, but the patient must continue meeting coverage requirements. A person can have fewer than 100 covered days if daily skilled care is no longer medically necessary under Medicare rules.

Conversely, care should not be ended simply because the person has “stopped improving” if skilled nursing or therapy is still needed to maintain the current condition or prevent or slow deterioration and the other requirements are met.

See Does Medicare Promise 100 Days of Rehab? for the coverage limit in more detail.

What is a Medicare benefit period?

SNF days are counted within Medicare benefit periods, not simply by the calendar year. A benefit period can include hospital and SNF care. Medicare explains that a benefit period ends after the person has not received inpatient hospital or SNF care for 60 days in a row.

If a new benefit period later begins and the beneficiary again meets Medicare’s requirements, a new set of Part A benefit days may become available. This does not mean benefits automatically “reset” on January 1.

For more, see The Medicare SNF Benefit Period: Why a New Year Does Not Automatically Reset It.

Can Medigap help with the day 21–100 coinsurance?

Some Medicare Supplement (Medigap) plans cover all or part of the skilled nursing facility coinsurance, depending on the standardized plan and the policy in force. Do not assume every Medigap policy pays the same amount.

Verify the exact policy before admission or before day 21. NHP’s guide Does Medigap Help With Skilled Nursing Copays? explains what to check.

Medicare Advantage costs can be different

A Medicare Advantage plan can use its own network, authorization, and cost-sharing rules within Medicare requirements. The plan may charge different copayments than Original Medicare and may waive the standard three-day inpatient hospital requirement.

Ask the plan for the current Evidence of Coverage or a written explanation of the SNF benefit. Also verify whether the specific facility is in network.

What if the family cannot afford the day-21 coinsurance?

Ask about possible secondary coverage before assuming the family must pay the full daily amount out of pocket. Depending on the person’s circumstances, help may come from:

  • a Medigap policy;
  • Medicaid for someone who meets the state’s financial and medical eligibility rules;
  • employer or retiree coverage;
  • other insurance benefits.

The SNF business office can explain its billing process, but eligibility decisions belong to the payer or public program—not the facility’s estimate.

What happens when Medicare-covered SNF care ends?

There are two separate questions:

  1. Does the person still need to live in a facility?
  2. Who will pay after Medicare coverage ends?

If the person still needs long-term nursing-home care but no longer meets Medicare’s skilled-coverage rules, payment may shift to private pay, Medicaid for an eligible resident, long-term-care insurance, or another source.

See What Happens When Medicare Stops Paying for Rehab? and Does Medicaid Pay for Nursing Home Care?.

Questions to ask before day 20

  • Which SNF day does the facility show today?
  • Does Medicare or the plan still consider the stay covered?
  • What will the daily patient responsibility be beginning on day 21?
  • Does Medigap, Medicaid, retiree coverage, or another payer cover any of that amount?
  • What notice will we receive if skilled coverage is expected to end?
  • What appeal rights apply?
  • If the resident stays after coverage ends, what is the facility’s private-pay daily rate?
  • If long-term care is needed, does the facility participate in Medicaid?

Compare the care plan and the payment plan separately

Do not choose a facility solely because of the day-21 copay. First confirm the clinical services and coverage; then compare what the family may owe. When a new facility is needed, browse senior-care communities and verify payer participation directly. If you need help sorting out rehab, long-term nursing-home care, or another setting, Get Help Finding Care can help you organize the decision.

Official sources

Reviewed October 24, 2026. The $217 daily SNF coinsurance is the 2026 Original Medicare amount and should be rechecked for later years. Medicare Advantage and supplemental coverage can differ. Confirm current benefits directly with Medicare or the beneficiary’s plan.

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