When Medicare stops paying for rehab

Somebody hands you a two-page form. It says her coverage ends Thursday.

Nobody sat you down. There was no meeting. A therapist said the word “plateaued,” or maybe nobody said anything at all and the notice just appeared on the bedside table while you were at work.

Read this part first, because it has a clock on it: that notice gives you the right to a free appeal, and if you file it in time, Medicare keeps paying while the appeal is decided. The deadline is usually noon of the day before her coverage is set to end.

Not Thursday. Noon on Wednesday.

If her memory is part of why she isn’t safe at home, be aware she may present far better to the reviewer than she does day to day. Showtiming, and why it undersells how much help she needs →

What the notice actually is

The form is a Notice of Medicare Non-Coverage — a NOMNC, form CMS-10123. It is two pages, it must be signed by you or her representative, and the facility is required to hand it over at least two calendar days before Medicare-covered services stop.

Note that carefully: two calendar days, not forty-eight hours. Plenty of websites say 48 hours. CMS says otherwise, and the difference can cost you the appeal.

The notice is not a bill. It is not a discharge. It does not mean she has to leave the building. It means one thing: Medicare is going to stop paying on this date, and you have the right to argue about it.

Two things are printed on that form and both matter enormously. The date coverage ends, and the phone number of the BFCC-QIO — the independent organization that reviews these decisions.

Circle both. Now.

The appeal: what to do in the next few hours

This is free, it is done over the phone, and you do not need a lawyer.

1. Call the BFCC-QIO number on the notice. Not the facility. Not the insurance company. The number on the notice. Do it the day you receive it — do not wait for the deadline, and confirm the exact cutoff with them on the call.
2. Say you are requesting an expedited appeal. Have her full name, her Medicare number, and the end date from the notice in front of you.
3. Ask for the DENC — the Detailed Explanation of Non-Coverage. The facility only has to produce it once you appeal. It tells you exactly what they are claiming, which tells you what to argue against.
4. Call her doctor the same day. Ask the physician to send the reviewer a written statement explaining why she still needs daily skilled care, and to take a phone call about it. This is the single highest-value thing you can do, and most families never think of it.
5. Ask the facility to send therapy and nursing notes to the reviewer today. Not tomorrow.
6. Write down every call. Who, when, what they said, and the case number.

The reviewer is supposed to decide within about 72 hours. And the burden is on the facility: legally, it has to prove its decision was right — not the other way round.

“She’s plateaued” is not a lawful reason to stop her care

This is the sentence you will hear, and it is why most families give up without appealing. It should not be.

Medicare coverage does not require improvement. Medicare’s own rules say she may get skilled nursing care if it is needed to help improve her condition, or to maintain her current condition, or to prevent or delay it from getting worse. The same is true of skilled therapy.

Coverage cannot be denied simply because a condition is chronic, stable, or unlikely to get better. Restorative potential is not required. This is the Jimmo settlement, it has been the law for more than a decade, and it is still ignored on the ground every single day.

So do not argue about fairness, and do not argue about money. Argue about skilled need and safety.

The strongest arguments sound like this:

• She still needs a licensed professional to do the thing safely — the wound, the medication titration, the transfer.
• Without continued skilled therapy she will lose the function she has, not merely fail to gain more.
• Her house has stairs and she cannot yet do stairs.
• She lives alone, and nobody will be there at two in the morning.

That last one is not an appeal to sympathy. Discharge safety is part of the clinical picture, and it belongs in the record.

What “daily skilled care” actually means

The standard the facility is applying, and rarely explains, is this: to keep Part A coverage she must need skilled nursing seven days a week, or skilled therapy at least five days a week.

Which means the decision often turns on something mundane. If therapy drops from five days a week to three, coverage can end — not because she got better, but because the schedule changed. It is worth asking the facility, in plain words: how many days a week is she being seen, and by whom?

Sometimes the honest answer to a coverage denial is not a legal argument at all. It is: why has her therapy been cut to three days?

What it costs you to appeal — the arithmetic nobody does

Families hesitate because they are afraid of a bill. Here is the actual exposure, plainly.

If you file the fast appeal by the deadline and the reviewer agrees with you, Medicare keeps paying and the care continues. You are out nothing.

If the reviewer agrees with the facility, you are responsible for care she receives after the end date printed on the notice. Since the review is decided within a couple of days of that date, the realistic downside is one or two days at the private rate.

Nursing home private rates run roughly $300 to $400 a day depending on where you live. So the bet is: risk a few hundred dollars for a shot at weeks of care Medicare pays for in full.

Most families never make that bet, because nobody explains it to them in those terms. Now somebody has.

If the first appeal fails

There are more levels, and you should know they exist — but you should also know the ground shifts under you at the second one.

• Level 2 — the QIC. If the first reviewer denies you, you can request an expedited reconsideration from a Qualified Independent Contractor, by noon of the next calendar day after the denial. They decide within 72 hours, and you can extend that to gather medical records.
• ⚠️ But the protection is gone. From this point, you are paying for the stay while the appeal is decided. That is a genuinely different financial decision, and you should make it with your eyes open.
• Levels 3 and beyond. An administrative law judge, then the Medicare Appeals Council, then federal court. These are real, they occasionally succeed, and they are far too slow to help with the bed she is in this week.

And if you missed the fast-appeal deadline entirely: call anyway. If she is still receiving care, you can generally request a standard appeal within 60 days. The rules and the financial exposure are different — but “you missed it” is not the same as “it’s over.”

Coverage ending is not the same as being discharged

These get conflated constantly, and they are two different things with two different sets of rights.

Medicare stopping payment means the bills become yours. It does not, on its own, mean she has to leave.

The facility moving to discharge her is a separate act, with its own written notice and its own appeal to the state. If a facility tells you she has to be out by Thursday because Medicare stopped paying, slow down and get help.

The help is free and almost nobody uses it: your state’s Long-Term Care Ombudsman. Every state has one. They advocate for residents, they handle exactly this, they cost nothing, and they are not connected to the facility. Ask the facility for the ombudsman’s number — they are required to have it posted.

While you are at it, ask for a care conference. You are entitled to sit down with the nurse, the therapist, and the social worker and hear the reasoning out loud. It is remarkable how often a plan changes in that room.

The 100 days, and what they really mean

Medicare Part A covers a skilled nursing facility stay for up to 100 days per benefit period — and only if she had a qualifying inpatient hospital stay of at least three days and entered the facility within 30 days of leaving the hospital.

In 2026, here is what that costs her:

• Days 1–20: $0 a day, after the Part A deductible of $1,736 — and she doesn’t pay it again if she already paid it for the hospital stay in the same benefit period.
• Days 21–100: $217 a day. Roughly $6,500 a month, and it surprises people badly.
• Day 101 and after: Medicare pays nothing. She pays everything.

Note what this means. “Up to 100 days” is a ceiling, not a plan. Coverage ends the moment she no longer needs daily skilled care — which for most people arrives long before day 100. Families hear “a hundred days” at the hospital and start counting to a hundred. The notice usually comes somewhere in the third or fourth week.

If she has a Medigap policy, check it: some plans pay all or part of that days 21–100 coinsurance.

Two rules that give the days back

Almost nobody explains these, and both of them matter.

The benefit period resets. The 100 days are not a lifetime allowance. A benefit period ends once she has been out of a hospital and out of a skilled nursing facility for 60 consecutive days. After that, a new benefit period begins — a new deductible, and a fresh 100 days. If she recovers, goes home, and is readmitted months later, she is not starting from zero benefits. She is starting from zero again, which is a very different thing.

The 30-day return window. If she leaves the facility and needs to go back within 30 days for the same condition, she generally does not need another three-day hospital stay to requalify. Families who bring someone home too soon, and then panic, often do not know this.

The trap that costs the most: observation status

Before you fight the notice, check one thing — because it may turn out there was never any coverage to lose.

Medicare will only pay for a skilled nursing stay if she was in the hospital as an admitted inpatient for at least three days. If the hospital kept her “under observation” instead — in a bed, on a ward, being treated, for three days — she was technically an outpatient the entire time. The three-day requirement was never met. Medicare pays nothing toward the rehab facility at all.

Families find this out at the billing office, with a number in the tens of thousands, having done absolutely nothing wrong.

The hospital is required to tell you if she has been under observation for more than 24 hours. Ask anyway, out loud, on day one: “Is she admitted as an inpatient, or is she under observation?” Ask again the next day, because it can change.

This is one piece of a larger fight that starts the day they raise discharge. Everything to ask, demand, and refuse before she leaves the hospital →

And if she was admitted as an inpatient and the hospital then switched her to observation status, that switch can be appealed — and you can ask for a fast appeal on it while she is still in the hospital.

If you take one thing from this page and it is not the appeal deadline, take this: ask the question in the hospital, before any of the rest of it happens.

Everything to ask, demand, and refuse before they send her home →

What if she’s on a Medicare Advantage plan?

The appeal rights exist, but the process runs partly through the plan, and the plan may have its own prior-authorization rules and its own network. Some Advantage plans waive the three-day hospital requirement entirely.

Call the number on the notice, call the plan, and ask both the same two questions: what is my deadline, and who do I call to appeal? Then write down the answers and the names.

When the appeal is over — win or lose

Eventually, and usually within days, the covered rehab ends. Then the real decision arrives, and it arrives fast: does she stay somewhere, or does she come home?

If she stays, it is roughly $300 to $400 a day out of pocket — nine to twelve thousand dollars a month — until either the money is gone or Medicaid takes over, which is a slow, invasive process with a five-year look-back that you cannot start on a Thursday.

If she comes home instead, here is what in-home care actually costs, and where the hours tip past the price of a facility →

So most families bring her home. Which is the right answer far more often than the industry admits.

But understand what you are walking into. Medicare may send home health — a nurse, a therapist, a few hours a week. It will not send anyone to get her out of the bath, or to be there at two in the morning. What Medicare pays for at home, and what it flatly does not →

Free help that has nothing to sell you

• Your BFCC-QIO — the number is on the notice. This is the appeal.
• Your Long-Term Care Ombudsman — free, in every state, and the right call if the facility starts talking about discharge rather than coverage.
• SHIP — your State Health Insurance Assistance Program. Free, confidential, unbiased Medicare counseling. They will walk you through the appeal and they are selling nothing.
• 1-800-MEDICARE (1-800-633-4227), or the plan directly if she is on Medicare Advantage.

Questions families ask when the notice arrives

How long do I have to appeal a Notice of Medicare Non-Coverage?

Usually until noon of the day before the end date printed on the notice. Call the BFCC-QIO number on the notice — do not wait, and confirm the exact deadline with them on the phone.

Does the care continue while the appeal is decided?

Yes, if you file by the deadline. An independent reviewer decides, usually within about 72 hours. If they rule against you, you become responsible for care given after the end date on the notice — realistically a day or two at the private rate.

Can Medicare stop paying because she has stopped improving?

No. Medicare covers skilled care needed to maintain her condition or to prevent or slow her decline, not just care that improves her. Improvement has never been required, and a denial resting on “she has plateaued” is a denial worth appealing.

What does Medicare actually pay for a rehab stay?

Up to 100 days per benefit period, after a qualifying three-day inpatient hospital stay. Days 1 to 20 cost $0 after the Part A deductible. Days 21 to 100 cost $217 a day in 2026. From day 101, Medicare pays nothing.

Do the 100 days ever come back?

Yes. Once she has been out of a hospital and out of a skilled nursing facility for 60 consecutive days, a new benefit period begins — a new deductible, and a fresh 100 days.

She was in the hospital three days. Why won’t Medicare pay for rehab?

Almost certainly because she was under observation rather than admitted as an inpatient. Observation is outpatient care, even in a hospital bed, and it does not satisfy the three-day inpatient requirement.

Does she have to leave the facility when Medicare stops paying?

Not automatically. Medicare stopping payment and the facility discharging her are two different things with two different sets of rights. If discharge is raised, call your state’s Long-Term Care Ombudsman — the service is free and it exists for exactly this.

Do I need a lawyer to appeal?

No. The fast appeal is free and done by phone. Your state’s SHIP program — free, unbiased Medicare counseling — will help you with it and is not selling anything.

What if I miss the deadline?

Call the BFCC-QIO anyway. If she is still receiving care you can generally request a standard appeal within 60 days, though the rules and the financial exposure are different.

Should I appeal even if I think we’ll lose?

Usually, yes. The downside is typically one or two days at the private rate; the upside is weeks of fully covered skilled care. Few decisions in this process have odds that good.

Last verified: 14 July 2026 against Medicare.gov skilled nursing facility and fast-appeal rules · Next review: January 2027, when CMS publishes new cost figures

This page is educational and is not medical or legal advice. Mark Duda is not a physician, a nurse, or an attorney. Appeal deadlines and financial liability depend on the exact notice you were given and on your own facts — follow the instructions printed on the notice and confirm every deadline with the organization named on it. Figures are current as of the verified date above. See our disclaimers.