Hospital to Skilled Nursing Facility in Illinois: Cost and Medicare Coverage

Your parent's doctor says they need rehab after the hospital—physical therapy, occupational therapy, maybe speech therapy after a stroke. The next step is a skilled nursing facility. But what does it cost, how long does Medicare pay, and what happens when coverage ends?

Here's what Illinois families need to know about the hospital-to-SNF transition.

The Three-Day Qualifying Stay

Before Medicare Part A covers any SNF care, your parent must have been admitted as an inpatient for at least three consecutive calendar days. The day of discharge doesn't count.

Critical distinction: observation status days do not count toward this requirement. If your parent spent four nights in the hospital but was classified as "observation" rather than "inpatient," Medicare considers the qualifying stay zero days—and won't cover SNF rehabilitation at all.

Verify inpatient status on admission day. Don't assume.

Medicare SNF Coverage: The 100-Day Breakdown

Once the three-day requirement is met, Medicare Part A covers SNF care in tiers:

• Days 1–20: Medicare pays 100% of covered services. No out-of-pocket cost to the patient.
• Days 21–100: Medicare pays everything above the daily coinsurance. In 2026, the patient (or their supplemental insurance) pays $204.00 per day.
• After Day 100: Medicare coverage ends completely. The patient pays the full private rate.

The 100-day maximum is per benefit period. A new benefit period begins after 60 consecutive days without skilled nursing or inpatient hospital care.

What SNF Care Costs in Illinois Without Medicare

When Medicare isn't covering—because the three-day rule wasn't met, observation status applies, or the 100-day cap is exhausted—families face the full private-pay rate:

• Semi-private room: $7,500–$9,500 per month across most Illinois markets
• Private room: $9,000–$12,000 per month
• Chicago metro facilities: Higher end of these ranges
• Central/Southern Illinois: Lower end, but still substantial

These costs add up fast. A 60-day stay beyond Medicare coverage at $9,000/month means $18,000 out of pocket.

What Medicare Covers in a SNF

Covered skilled services include:

• Physical therapy (mobility, strength, balance)
• Occupational therapy (daily living activities, fine motor skills)
• Speech-language pathology (swallowing, communication after stroke)
• Skilled nursing care (wound care, IV medications, injections)
• Medical social services
• Medications administered by facility staff
• Semi-private room and meals
• Medical equipment used during the stay

Medicare does not cover custodial care—help with bathing, dressing, and eating that doesn't require skilled nursing or therapy.

When Medicare Stops Paying

Medicare terminates SNF coverage when either:

• The patient has reached the 100-day maximum for the benefit period
• The clinical team determines the patient no longer needs daily skilled care (they've plateaued or met their goals)

The facility must deliver a Notice of Medicare Non-Coverage (NOMNC) at least two days before covered services end. You have the right to appeal this termination through the same Acentra Health QIO process used for hospital discharge appeals (888-317-0751).

While the appeal is pending, the patient remains covered.

The Illinois Choices for Care Screening

Before your parent enters any Medicaid-certified SNF or Supportive Living Facility in Illinois, the hospital must complete a Choices for Care pre-admission screening. This process:

1. The hospital submits a PASRR Level I screen through AssessmentPro at least 24 hours before discharge
2. The regional Care Coordination Unit (CCU) conducts a face-to-face Determination of Need (DON) assessment within 24 hours
3. A DON score of 29 or higher qualifies for facility admission

The CCU must complete Forms HFS 2536 and HFS 3864—without these signed forms, the receiving SNF cannot secure Medicaid reimbursement, creating financial liability for the family.

Planning for After Medicare's 100 Days

If your parent will need care beyond what Medicare covers:

• Medicaid: If assets are below $17,500 and income below $1,330/month, Illinois Medicaid covers ongoing nursing home care. Start the application during the Medicare-covered period so approval is ready when Part A ends.
• Long-term care insurance: If your parent has a policy, notify the insurer immediately upon SNF admission. Many policies have elimination periods (usually 90 days) that begin counting from day one.
• Veterans Aid & Attendance: If your parent is a veteran or surviving spouse, this pension benefit can provide $1,000–$2,700/month toward facility costs.

Choosing the Right SNF in Illinois

Not all facilities are equal. Before agreeing to a transfer:

• Check Medicare's Care Compare tool (medicare.gov/care-compare) for star ratings, staffing levels, and inspection results
• Ask the hospital discharge planner which facilities have immediate bed availability
• Verify the facility accepts Medicare and, if relevant, Medicaid (for potential long-term conversion)
• Visit if possible—even a 30-minute walk-through reveals staffing ratios and cleanliness

The Hospital-to-Home Illinois toolkit includes an SNF admission worksheet covering what to ask, what to sign (and what to refuse to sign), and how to protect yourself from personal financial guarantees.

See more Illinois guides →