Paying for care

Hospital says you need rehab? How to choose a nursing home before discharge

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By Nursing Home Checker · Updated Oct 12, 2026 · How guides are checked · Share

When a hospital says a patient needs short-term rehab or skilled nursing care after discharge, families often have little time to decide. Federal rules for hospitals say the choice belongs to the patient and family, and set out what the hospital must give you to make it.

What the hospital must do

Hospitals that take part in Medicare must follow federal discharge planning rules (42 CFR § 482.43). Among them:

• Focus on the patient's goals. Discharge planning must focus on the patient's goals and treatment preferences, and treat the patient and caregivers as active partners.
• Give a list. When skilled nursing care is indicated, the hospital must give a list of Medicare-participating skilled nursing facilities available to the patient, in the geographic area the patient requests.
• Let you choose. The hospital must tell the patient or representative that they are free to choose among Medicare-participating providers, respect their preferences when possible, and not specify or otherwise limit the qualified providers available to the patient.
• Share quality data. The hospital must help the patient and family choose by using and sharing data on quality measures and resource use for skilled nursing facilities and other post-acute providers, relevant to the patient's goals of care and treatment preferences.
• Disclose financial interests. The discharge plan must identify any skilled nursing facility or home health agency to which the patient is referred in which the hospital has a disclosable financial interest, or that has one in the hospital.
• Talk it through. The results of the discharge planning evaluation must be discussed with the patient or the patient's representative.

Medicare's own discharge planning checklist also points families to Medicare's Care Compare tool to compare nursing homes and home health agencies.

Will Original Medicare pay for the nursing home?

Original Medicare (Part A) generally pays for care in a skilled nursing facility only when all of these are true:

• The patient had a medically necessary inpatient hospital stay of at least 3 days in a row. The day of discharge does not count.
• The patient generally goes to the skilled nursing facility within 30 days of leaving the hospital. Federal rules allow a later start when skilled nursing care would not be medically appropriate within 30 days.
• The patient needs skilled nursing or skilled rehab every day that, as a practical matter, can only be given as an inpatient in a skilled nursing facility, for a condition treated in the hospital, or one that arose while getting skilled nursing facility care for that condition.
• A doctor or other provider decides the daily skilled care is needed, the patient has Part A days left in the benefit period, and the facility is Medicare-certified.

Medicare says a 3-day inpatient stay may not be needed if the patient's doctor is part of an Accountable Care Organization approved for a skilled nursing facility 3-day rule waiver. You can ask the doctor whether this applies.

Observation status: why "inpatient" matters

Medicare says time spent as an outpatient under observation, or in the emergency room before admission, does not count toward the 3-day inpatient stay. A person can be an outpatient even after a night in the hospital; inpatient status starts with a doctor's order and formal admission. If a Medicare patient gets observation services for more than 24 hours, the hospital must give the Medicare Outpatient Observation Notice (MOON), which explains the status and how it affects costs.

Since February 14, 2025, Medicare says a patient with Original Medicare who was admitted as an inpatient and then had their status changed to outpatient observation can ask for a fast appeal, and should get a Medicare Change of Status Notice. If the BFCC-QIO decides the status should not have changed, Medicare says the patient may qualify for a Medicare-covered skilled nursing facility stay within 30 days of discharge, if other coverage requirements are also met.

What it costs in 2026

Medicare says the patient pays $0 a day for days 1–20 after the $1,736 Part A deductible, but does not have to pay that deductible for skilled nursing facility care if it was already paid for hospital care in the same benefit period. Medicare covers these days only while the patient still needs daily skilled care. A benefit period ends after the person has been out of the hospital, and not getting skilled care in a skilled nursing facility, for 60 days in a row. Medicare does not cover custodial care, such as help with bathing, dressing or eating, when that is the only care needed. See does Medicare cover nursing homes and short-term rehab vs. long-term care.

If the patient has a Medicare Advantage plan

Medicare says Medicare Advantage plans may charge copayments during the first 20 days and may waive the 3-day hospital stay. Medicare also says Medicare Advantage members may need to use providers in the plan's network and may need the plan's approval (prior authorization) before it covers certain services. Hospitals must tell patients in managed care plans to check with their plan which providers are in its network.

Under a CMS rule, starting in 2026 Medicare Advantage plans generally must send prior authorization decisions within 72 hours for urgent requests and 7 calendar days for standard ones, and must give a specific reason when they deny a request. In June 2026 the HHS Office of Inspector General reported that in June 2024 the 19 Medicare Advantage companies in its review together denied 12 percent of requests for skilled nursing facility admission. Enrollees and their providers appealed 18 percent of those denials, and the companies overturned 95 percent of appealed denials in the enrollee's favor.

If you think the discharge is too soon

Medicare says hospital inpatients should get a notice called the Important Message from Medicare within 2 days of admission and again before discharge. It explains the right to a fast appeal. If you contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) named on the notice no later than the scheduled discharge day, the patient can stay while waiting for the decision without paying for the stay, apart from any coinsurance or deductibles.

When Medicare stops paying for the nursing home

Medicare says you should get a Notice of Medicare Non-Coverage at least 2 days before covered skilled nursing facility services end. You can ask the BFCC-QIO for a fast appeal by noon the day before the end date on the notice. If the BFCC-QIO decides the services should end, Medicare says the patient won't pay for services before the end date on the notice, but may have to pay for services after it. If the stay may turn into long-term care, see how Medicaid pays for a nursing home.

Other options after a hospital stay

• Home health. Medicare covers home health when a doctor or other provider orders it after seeing the patient in person, the patient needs part-time or intermittent skilled care, the patient is homebound, and a Medicare-certified home health agency provides the care. Covered home health services cost $0 (medical equipment is 20% after the Part B deductible). You can compare home health agencies on this site.
• Hospice. Medicare covers hospice for people with Part A whose hospice doctor and regular doctor (if they have one) certify that they are terminally ill with a life expectancy of 6 months or less, and who accept comfort care instead of care to cure their illness. You can look up hospices here.
• Inpatient rehabilitation or a long-term care hospital. Medicare.gov says inpatient rehabilitation can help someone recovering from a serious surgery, illness or injury who needs an intensive rehabilitation therapy program, physician supervision and coordinated care, and that long-term care hospitals typically care for patients with more than one serious medical condition. You can see CMS quality data for inpatient rehabilitation facilities and long-term care hospitals here.