The rules for Medicare coverage
Skilled nursing facility (SNF) care is short-term nursing or rehabilitation, such as therapy after a hip fracture, a stroke or surgery. Original Medicare covers it when:
- You had a qualifying inpatient hospital stay of at least three days in a row (observation days don't count).
- You enter a Medicare-certified SNF, generally within 30 days of leaving the hospital, for a condition treated there or one that started while you were in the SNF.
- Your doctor orders daily skilled care that can only be given by, or under the supervision of, skilled nursing or therapy staff.
What you pay in 2026
| Days per benefit period | You pay |
|---|---|
| Days 1 to 20 | $0 |
| Days 21 to 100 | $217 per day |
| Day 101 and after | All costs |
Medigap Plans C, D, F, G, M and N pay the daily coinsurance for days 21 to 100, and Plans K and L pay part of it. Medicare Advantage plans must cover SNF care too, but they may waive the three-day stay, require prior authorization, limit you to network facilities and set different cost sharing, so read your plan's Evidence of Coverage.
What isn't covered
- Custodial care when help with bathing, dressing and eating is all you need.
- SNF care without a qualifying inpatient stay under Original Medicare.
- Care in a facility that isn't Medicare-certified, or after day 100.
Long-term nursing facility care in Oregon is a Medicaid benefit for people who qualify, run by the Oregon Department of Human Services (ODHS) Aging and People with Disabilities program (1-855-673-2372). See our dual-eligible guide and the nursing home page.
If your stay is ending too soon
At least two days before covered services end, the SNF must give you a Notice of Medicare Non-Coverage. If you disagree, ask for a fast appeal from Acentra Health, the quality improvement organization for Oregon, by noon the day before the end date. See Medicare appeals in Oregon.
Related questions
Does Medicare cover nursing home care in Oregon?
Skilled care versus long-term care.
Does Medicare cover home health in Oregon?
Care after you go home.
Does Medicare cover physical therapy in Oregon?
Outpatient and inpatient therapy.
Sources
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Fast appeals
- CMS — Quality Improvement Organizations
- Oregon Department of Human Services — Long-term care
More questions in this guide
- Does Medicare cover acupuncture in Oregon?
- Does Medicare cover ambulance service in Oregon?
- Does Medicare cover annual physicals in Oregon?
- Does Medicare cover assisted living in Oregon?
- Does Medicare cover bone density tests in Oregon?
- Does Medicare cover cataract surgery in Oregon?
- Does Medicare cover chiropractic care in Oregon?
- Does Medicare cover a colonoscopy in Oregon?
- Does Medicare cover CPAP machines in Oregon?
- Does Medicare cover dental care in Oregon?
- Does Medicare cover diabetic supplies in Oregon?
- Does Medicare cover flu shots in Oregon?
- Does Medicare cover hearing aids in Oregon?
- Does Medicare cover home health care in Oregon?
- Does Medicare pay for in-home caregivers in Oregon?
- Does Medicare cover mammograms in Oregon?
- Does Medicare cover me when I travel or spend winters outside Oregon?
- Does Medicare cover medical marijuana in Oregon?
- Does Medicare cover memory care in Oregon?
- Does Medicare cover mental health care in Oregon?
- Does Medicare cover naturopathic doctors in Oregon?
- Does Medicare cover nursing home care in Oregon?
- Does Medicare cover oxygen therapy in Oregon?
- Does Medicare cover physical therapy in Oregon?
- Does Medicare cover prostate cancer screening in Oregon?
- Does Medicare cover psilocybin therapy in Oregon?
- Does Medicare cover the shingles vaccine in Oregon?
- Does Medicare cover transportation to medical appointments in Oregon?
- Does Medicare cover vision care in Oregon?
- Does Medicare cover wheelchairs in Oregon?
Part of the guide: Learn Medicare — the Oregon starter guide · All questions
Frequently asked questions
Do observation days count toward the three-day stay?
No. Only days you were formally admitted as an inpatient count for Original Medicare. Observation is outpatient care, even if you stayed overnight, so ask the hospital about your status.
Can I appeal if the facility says my coverage is ending?
Yes. Call Acentra Health, Oregon's Medicare quality improvement organization, at 1-888-305-6759 by noon the day before the date on your Notice of Medicare Non-Coverage. You generally aren't billed while the fast appeal is decided.
When do my 100 days start over?
A new benefit period starts after you have gone 60 days in a row without inpatient hospital or skilled nursing care. Then a new qualifying hospital stay can start a new 100 days.
Medicare in your Oregon county
Plans, local agents and help, county by county: Multnomah · Washington · Clackamas · Lane · Marion · Jackson · Deschutes · Linn · Douglas · Yamhill · Benton · Polk · Josephine · Umatilla · Klamath · Coos · Columbia · Lincoln · Clatsop · Malheur · All 36 counties →
