Leaving Rehab: When Medicare Skilled-Nursing Coverage Ends

What the “Notice of Medicare Non-Coverage” really means

Medicare covers skilled nursing (SNF) rehab only while the person is still making measurable progress, and never past 100 days in a benefit period — fully for the first 20 days, then with a daily copay through day 100. When the therapy team decides progress has plateaued, coverage ends, often well before day 100. The facility must give you a Notice of Medicare Non-Coverage at least two days before the last covered day. That notice is not a discharge order and it is not a statement that your parent no longer needs care — only that Medicare will stop paying for this level of care.

You can appeal — and it is free while you do

If you believe rehab is ending too soon, the notice has a phone number for a BFCC-QIO reviewer. Call by the deadline printed on the form (usually noon the day before the planned end date). While the fast appeal is pending, Medicare keeps paying — you are not charged for the extra days if you lose, and a decision usually comes within about 48 hours. Even when an appeal does not change the date, it buys you time to arrange the next place calmly. Photograph the notice the moment you receive it.

The choice of where they go next is yours, not the facility’s

The SNF’s discharge planner or social worker will help arrange the move, and that help is real — but the decision about which place your parent goes to belongs to your family. A facility cannot direct you to a specific business, and if it has a financial interest in one it must disclose that. You are allowed to say “we need a few days to visit options,” to ask for a short extension, and to decline the first bed offered. The pressure to decide by tomorrow is real, but the right to choose is real too.

Why the social worker often can’t place you into assisted living

Here is the gap that catches nearly every family. Hospital and SNF discharge teams are built around medical, Medicare-covered settings — another skilled nursing bed, home health visits, or hospice. Assisted living and board-and-care (RCFEs) are custodial, private-pay settings that Medicare does not cover, so most discharge teams have no referral relationships there and cannot place your parent into one. If the plan for your parent is assisted living or memory care rather than more skilled nursing, you are the one who finds it — usually on a few days’ notice, which is exactly why it feels so sudden.

Where your parent might go — and who pays

• Assisted living (RCFE) — help with bathing, dressing, meals, and medications in a residential setting. Private pay; Medicare does not cover it. In California, the Assisted Living Waiver can help some Medi-Cal-eligible residents pay.
• Memory care — a secured RCFE for dementia, with staff trained for wandering and behavior needs. Also private pay.
• In-home care — caregivers at home for bathing, meals, and supervision. Private pay or, for eligible low-income seniors, In-Home Supportive Services (IHSS).
• Long-term skilled nursing — if your parent needs ongoing medical care, not just help with daily activities. Long-term stays are typically private pay or Medi-Cal, not Medicare.

Not sure which fits, or how to pay for it? See types of senior care and how to pay for care.

A short action list for the next 48 hours

• Ask the social worker, in writing, what level of care they are recommending at discharge — skilled nursing, assisted living, memory care, or home — and why.
• If you disagree with the timing, call the QIO number on the notice before the deadline to start a fast appeal.
• Build a short list of licensed facilities in the right towns and care type, and call to confirm openings before you visit. Our Placer County directory is filtered by town and care type, and each listing links to the official state license record.
• Ask each facility whether they can take a resident on short notice from a rehab discharge, and what they need from the SNF (a current care assessment, medication list, and often a TB test).
• Bring our tour questions checklist, and verify the license of any place before you commit.