How Long Does Medicare Pay for Rehab After a Hospital Stay in Massachusetts?

Your father had hip replacement surgery at Mass General. The surgeon says he needs weeks of physical therapy at a skilled nursing facility. The question keeping you up at night: how long will Medicare actually pay for this, and what happens when it stops?

The Three-Day Inpatient Requirement

Medicare Part A covers skilled nursing facility (SNF) care only after a qualifying hospital stay of three consecutive inpatient days. The admission day counts; the discharge day does not. A Monday admission through Thursday discharge meets the threshold.

The critical trap: days under "observation status" do not count. If your parent spent two days as an inpatient and one day under observation, they have only two qualifying days — and Medicare will not cover the SNF stay. Massachusetts law (MGL c. 111, § 51K) requires hospitals to notify patients of observation status within 24 hours, giving families a window to advocate for reclassification.

The 100-Day Coverage Window

Once the three-day requirement is met, Medicare Part A covers:

• Days 1–20: 100% covered by Medicare. No copay.
• Days 21–100: Medicare covers the facility cost minus a daily coinsurance of $217.00 (2026 rate). If your parent has a Medigap supplemental plan, it may cover this coinsurance.
• After Day 100: Medicare coverage ends entirely. The family pays the full private rate — over $14,000 per month at the average Massachusetts skilled nursing facility.

The 100-day clock starts on the day of SNF admission, not the hospital discharge date. Any gap of 60 consecutive days without skilled care resets the benefit period, allowing a new 100-day window after another qualifying hospital stay.

When the Facility Says Your Parent Has "Plateaued"

Medicare does not guarantee 100 days. Coverage continues only as long as the patient requires daily skilled nursing or therapy services and is making clinical progress. The facility can issue a Notice of Medicare Non-Coverage (NOMNC) at any time, declaring that the patient has "plateaued" and no longer needs skilled care.

In practice, many families see this notice arrive around day 20–30, just as the coinsurance kicks in and the facility's financial incentive shifts.

How to Appeal an Early Rehab Discharge

When you receive the NOMNC, you have until noon on the calendar day before the listed termination date to file an expedited appeal with Acentra Health (1-888-319-8452), the Massachusetts BFCC-QIO.

Once you file:

• The facility cannot stop services during the review
• Acentra Health has 72 hours to issue a decision
• If upheld, Medicare coverage continues
• If denied, you can request an Expedited Reconsideration from the Qualified Independent Contractor (C2C Innovative Solutions) by noon the next calendar day

The strongest appeals include a letter from the patient's physician documenting ongoing clinical progress and specific skilled care needs that cannot be met at home.

Planning for What Comes After Medicare

Even with a full 100-day benefit, families should start planning for the coverage gap early. Options in Massachusetts include the Frail Elder Waiver (for patients meeting nursing facility level of care who want to return home), the State Home Care Program, and MassHealth Standard for long-term nursing home coverage — though financial eligibility requires assets under $2,000 for an individual.

Get the Complete Medicare SNF Coverage Guide

The Massachusetts Hospital-to-Home Transition Toolkit includes the NOMNC appeal script, a day-by-day coinsurance calculator, and a step-by-step timeline for transitioning from Medicare-covered rehab to community or long-term care options.

See more Massachusetts guides →