When Medicare-covered skilled nursing care is ending, start with the written reason and notice deadline. The end of a covered stay does not mean all Medicare benefits disappear, but remaining in the facility can create costs that Medicare does not pay.
Find out why coverage is ending
| Possible reason | Question to ask |
|---|---|
| Skilled-care requirements are no longer met | Which documented need or benefit condition changed? |
| Part A SNF days are exhausted | How were days counted in this benefit period? |
| Plan authorization or other denial | What written decision and review rights apply? |
| Only residential or personal care is needed | What separate long-term-care charges and assistance options exist? |
Read the notice immediately
For a Notice of Medicare Non-Coverage, follow the BFCC-QIO fast-appeal instructions by the stated deadline, generally no later than noon the day before the listed termination date. Ask for the notice if you have not received it. A benefits phone call or complaint does not substitute for an appeal request.
Ask the treating team for the care records relevant to the decision. If skilled care is needed to maintain function or slow decline, lack of improvement alone is not the entire coverage test. An appeal still needs the facts of your case and does not guarantee continued payment.
Request a written payment and care plan
Separate the cost of staying in the facility from covered doctor visits or other eligible medical services. Ask which charges start on which date, and whether a different covered care setting may be appropriate. A short break does not automatically reset the SNF benefit period.
Medigap generally does not pay custodial residence or create extra SNF days after Medicare benefits are exhausted. Review any separate long-term-care policy. Contact the state Medicaid office about its eligibility rules; Medicaid does not switch on automatically.
Organize help before making a move
- Meet with the discharge planner or social worker.
- Clarify supervision, equipment and transport needs with the care team.
- Obtain the facility’s itemized charges and agreement.
- Keep coverage notices and appeal reference numbers.
- Ask local aging and disability services about available support.
A coverage decision and a safe discharge plan are separate issues that both need attention. Do not assume one notice answers every question about residence, payment and ongoing care.
Related coverage questions
- Nursing Home Care and Medicare: Understand the Difference
- Medicare Skilled Nursing Facility Coverage: The 100-Day Limit Explained
- Medicare Advantage and Nursing Homes: Skilled Care Versus Residence