Medicare After a Hospital Stay

After a hospital stay, Medicare can pay for rehab in a nursing facility or a nurse at home. It also helps pay for equipment and doctor visits. Your doctor decides what you need, and the discharge planner sets it up before you go home. Going home can feel rushed, with new pills and a ride to sort out.

Medicare may pay if

• Your doctor says you need skilled care, like a nurse or therapist.
• For a nursing facility, you were an inpatient for 3 days in a row.
• The place giving the care works with Medicare.

Not sure Medicare will pay? Ask anyway, because the discharge planner can check before you go. Or a Pair Team advocate can help you sort it out.

What Medicare pays for during and after a hospital stay

Does Medicare pay for a nursing home after a hospital stay?

Yes, Medicare pays for a short nursing home stay if you need skilled care every day. Examples are medicine given through a vein and physical therapy. You must have been an inpatient for 3 days in a row, not counting the day you leave. You usually need to go within 30 days.

Medicare pays for up to 100 days in each benefit period. It does not pay for a long stay if you only need help with bathing or dressing. Ask the discharge planner about other help.

Why does observation status matter?

Observation status matters because days "under observation" do not count toward the 3 inpatient days you need for a nursing facility. You can spend two nights in a hospital bed and still be an outpatient. You're an inpatient only once a doctor writes an order to admit you.

If you're under observation over 24 hours, the hospital must give you the Medicare Outpatient Observation Notice (MOON).

If you were admitted and then switched to observation, you should get the Medicare Change of Status Notice. With Original Medicare, you can ask for a fast appeal before you leave.

Does Medicare pay for home health care?

Yes, Medicare pays for home health care, and you pay $0 if:

• Leaving home takes a lot of effort. You need a walker, a ride or another person to get out, or your doctor says to stay in.
• You need part-time skilled care, like wound care or therapy.
• A doctor or nurse practitioner saw you in person and ordered it.

You can still go to the doctor, church or adult day care, and you don't need a hospital stay first. Home health does not cover 24-hour care, so for more help, see paying for a caregiver.

What to do before you leave the hospital

1. Ask your status every day: "Am I an inpatient or under observation?"
2. Meet the discharge planner to get your plan in writing: where you'll go, your medicines and your next doctor visit.
3. Pick your providers. The hospital should give you a list of nursing facilities and home health agencies to choose from.
4. Order equipment now, so it gets home before you do. See what Medicare pays for walkers, wheelchairs and beds. Original Medicare does not pay for shower chairs or grab bars, so see who pays for bathroom safety items. If your home health includes occupational therapy, you can ask the therapist to check your bathroom.
5. See your regular doctor soon after you get home. Bring every pill bottle so the doctor can check them. For a way there, see rides to medical appointments.

You can ask for a fast appeal if you are sent home too soon

Within 2 days of admitting you, and again before you leave, the hospital must give you the Important Message from Medicare. If you think you're going home too soon, call the number on it before you leave. That reaches the Quality Improvement Organization (QIO), which reviews cases for Medicare. If you call in time, you can stay while you wait, at no extra cost. The QIO decides within one day of getting your records.

A nursing facility or home health agency should warn you in writing at least 2 days before your care ends. This is the Notice of Medicare Non-Coverage. To appeal, call the number on it by noon the day before your care ends. For other denials, see how to appeal a Medicare denial.

Medicare Advantage plans may have different rules

If you have a private Medicare plan, call it before you leave. It may skip the 3-day rule or charge a copay for days 1 to 20. It may need to approve your care first, and only pay for places in its network. It cannot charge more than Original Medicare for nursing facility care, and you still have the right to a fast appeal.

What a Pair Team advocate does

Many people call us in the first weeks home, when home health hasn't started or there's no ride to the doctor. Here's how we help:

• Go over your discharge papers and medicines with you, with a nurse on the line.
• Call the home health agency or supplier until visits start and the equipment shows up.
• Set up your follow-up visits and a ride there.
• Help with what often comes next: food, utility bills, help at home and appeals.

An advocate is covered by Medicare if you qualify. It takes two minutes to find out.

Check if you qualify for a Pair Team advocate

Frequently asked questions

Will Medicare pay for all 100 days?

Medicare pays for all 100 days only while you need skilled care every day. After that, Medicare stops paying, even with days left. You can appeal if you still need care.

What if I go back to the hospital?

If you go back within 60 days, you're in the same benefit period and don't pay the $1,736 deductible again. After 60 days in a row out of care, a new one starts.

Does anything help pay the $217 a day?

Yes, most Medigap plans pay some or all of it. The Qualified Medicare Beneficiary (QMB) program, one of the Medicare Savings Programs, can pay it too.

Can I pick the nursing facility or home health agency?

Yes, you can pick, and you can compare places at medicare.gov/care-compare. The hospital must tell you if it has a stake in any place on its list.

Will Medicare pay for help with bathing after surgery?

Medicare pays for help with bathing only as part of home health, when you also get nursing or therapy. It does not pay if help with daily tasks is all you need, so ask the discharge planner about other help.

Sources

• Skilled nursing facility care, Medicare.gov
• 2026 Medicare Parts A and B Premiums and Deductibles, CMS
• Inpatient hospital care, Medicare.gov
• Inpatient or outpatient hospital status affects your costs, Medicare.gov
• Appealing a change in status during a hospital stay, Medicare.gov
• Home health services, Medicare.gov
• Durable Medical Equipment Reference List (National Coverage Determination 280.1), CMS
• Home Health Occupational Therapy (L34560), CMS Medicare Coverage Database
• Fast appeals, Medicare.gov
• Health Maintenance Organizations (HMOs), Medicare.gov
• Compare Medigap plan benefits, Medicare.gov
• Eligibility for home health, Medicare Interactive