A fall, stroke, fracture, heart failure episode, or serious infection can send your parent from the hospital to rehabilitation in a matter of days. Then comes a difficult question: can your parent safely return home, or is ongoing nursing-facility care needed?
Understanding the steps, and the payment rules, can help you make decisions with fewer surprises. Medicare can cover a limited period of skilled nursing facility care, but it does not pay indefinitely for long-term custodial care. In Maryland, families often need to plan for private payment, long-term care insurance, veterans’ benefits, or Medicaid.
1. At the hospital: Ask about inpatient or observation status
After emergency treatment, the hospital team decides whether your parent needs an inpatient admission. A discharge planner or case manager should begin discussing next steps early, especially if your parent will need therapy or help with daily activities.
One detail can affect whether Original Medicare covers rehabilitation at a skilled nursing facility (SNF): your parent’s hospital status.
- Inpatient: A doctor formally admits your parent as a hospital inpatient.
- Observation: Your parent receives hospital services as an outpatient, even if they stay overnight.
Observation time does not count toward Original Medicare’s three-day inpatient requirement for SNF coverage. Ask the hospital every day: “Is my parent an inpatient or under observation?” If your parent receives a Medicare Outpatient Observation Notice (MOON), ask the case manager how the status affects the next step.
Medicare Advantage plans can have different requirements, including waivers of the three-day rule. Call the plan to confirm its coverage. Medicare explains how hospital status affects SNF coverage.
2. Discharge to rehab: Know the three-day rule
“Rehab” commonly means a Medicare-certified skilled nursing facility where your parent receives services such as physical, occupational, or speech therapy, or skilled nursing care.
For Original Medicare to cover SNF care, your parent generally must:
- Have a qualifying hospital stay of at least three consecutive inpatient days. The admission day counts; the discharge day does not. Observation and emergency-room time do not count.
- Enter a Medicare-certified SNF generally within 30 days of leaving the hospital.
- Need daily skilled nursing care or skilled therapy related to the hospital stay, and have Part A coverage and benefit days available.
The hospital discharge planner can help identify facilities, but ask questions before choosing:
- Is this facility Medicare-certified, and does it accept your parent’s insurance?
- Is it in-network for a Medicare Advantage plan?
- What therapy services and discharge planning does it provide?
- How will the team communicate progress and expected discharge timing?
Medicare covers skilled care, not simply a need for help with meals, bathing, or supervision. Coverage can end when skilled care is no longer medically necessary, even if fewer than 100 days have passed. Read Medicare’s SNF coverage rules.
3. How Original Medicare pays for SNF care in 2026
Medicare Part A measures SNF use in a benefit period. For 2026, Original Medicare’s SNF cost-sharing rules are:
- Days 1–20: $0 per day after the applicable Part A deductible.
- Days 21–100: $217 per day.
- After day 100: Medicare pays nothing for SNF care in that benefit period.
There is no separate SNF deductible if your parent already paid the Part A hospital deductible during the same benefit period. The 2026 Part A deductible is $1,736. A new benefit period begins after your parent goes 60 consecutive days without inpatient hospital care or skilled SNF care. The dollar figures change each year.
Most importantly, Medicare does not promise 100 covered days. Your parent must continue to meet the skilled-care requirements. If that need ends on day 18, for example, Medicare coverage can end then.
4. Can supplemental insurance help?
If your parent has Original Medicare and a Medigap policy, the policy may cover some or all of the $217 daily SNF coinsurance for days 21–100.
Under standardized Medigap benefits:
- Plans C, D, F, G, M, and N cover the full SNF coinsurance for covered days 21–100.
- Plans A and B do not cover that coinsurance.
- Plans K and L cover a portion-50% and 75%, respectively.
Plan C and Plan F are generally unavailable to people first eligible for Medicare on or after January 1, 2020. High-deductible plans also have different cost-sharing rules. Check the actual policy; a Medigap policy works with Original Medicare, not Medicare Advantage. Compare standardized Medigap benefits.
With a Medicare Advantage plan, the plan must cover Medicare-covered services, but cost-sharing, facility networks, prior authorization, and discharge review depend on the plan. Call the insurer promptly and ask what the family owes and what happens if coverage is denied. Some retiree plans and Medicaid coverage for eligible dual beneficiaries can also help with cost-sharing.
Find the insurance cards early. Locate your parent’s Medicare card, supplemental or Medicare Advantage card, and any retiree or long-term care insurance policy in the first few days.
5. During rehab: Decide whether home is safe
The rehab team tracks progress and considers what support your parent will need after discharge. Ask for a care-planning meeting and discuss:
- Transfers, walking, toileting, bathing, and dressing
- Cognition, judgment, and ability to manage medications
- Home safety, stairs, equipment, and accessibility
- The amount of supervision and hands-on help needed
- Whether family caregivers can realistically provide that help
Possible next steps include returning home with home care and modifications, returning home with family support, moving to assisted living, or transitioning to a nursing facility. A nursing facility provides 24-hour nursing oversight, medication management, meals, supervision, and activities. When your parent needs around-the-clock care that cannot be safely provided at home, nursing-facility care can be the safer option.
This is often one of the hardest decisions a family faces. Repeated falls, wandering, unsafe cooking, missed medications, repeated hospitalizations, or caregiver exhaustion are signs to take seriously.
6. After Medicare coverage ends: Who pays for long-term care?
Medicare does not cover ongoing custodial nursing-home care. Assistance with daily activities when skilled treatment is no longer needed. If your parent stays in a nursing facility after Medicare coverage ends, the family needs to identify another payment source.
Private pay
Payment can come from your parent’s income, savings, investments, retirement accounts, or the sale of assets. The most recent published CareScout survey figures for Maryland, released in 2026 from 2025 data, put median nursing-home costs at approximately:
- $12,927 per month for a semi-private room
- $14,448 per month for a private room
That is roughly $155,000–$173,000 per year. Actual prices vary by facility, location, and care needs. See the CareScout cost-of-care survey.
Other possible sources
- Long-term care insurance: Check the policy’s elimination period, daily benefit, covered services, and benefit duration.
- VA benefits: Veterans and surviving spouses should ask the VA or an accredited veterans’ benefits representative about potential eligibility.
- Maryland Medicaid: Medicaid can cover nursing-facility care when your parent meets medical and financial requirements.
In 2026, a single applicant generally must have no more than $2,500 in countable assets to meet Maryland’s long-term-care resource limit. A married applicant’s situation is different: spousal-impoverishment rules protect resources for the spouse living at home. The 2026 maximum Community Spouse Resource Allowance is $162,660; the amount protected in a particular case depends on the couple’s finances and eligibility calculation. The person receiving care generally contributes income toward the cost, subject to applicable allowances and rules.
Maryland also reviews asset transfers made during the five years before an application. Gifts or transfers for less than fair market value can create a period of Medicaid ineligibility. Do not rush to give away money or transfer a home. The rules are fact-specific, and transfers made without advice can create serious problems.
If your parent is already in a facility, it is not necessarily too late to explore options. Contact an elder law attorney before spending down assets or making transfers. A facility or hospital discharge planner can help start an application, but they do not replace individualized eligibility advice. Learn more about planning for long-term care and Medicaid eligibility.
7. What to do in the first week
- Gather Medicare, supplemental, Medicare Advantage, retiree, and long-term care insurance cards and policies.
- Ask the hospital daily whether your parent is inpatient or under observation.
- Request a hospital discharge-planning meeting.
- Confirm the rehab facility is Medicare-certified and, if relevant, in-network.
- Keep a notebook of admission and discharge dates, SNF start date, and insurance calls.
- Track Medicare-covered days and ask the rehab team whether skilled care is expected to continue.
- Ask therapists for realistic functional goals and a clear discharge plan.
- Speak with an elder law attorney before transferring assets or paying large sums from your parent’s savings.
Frequently asked questions
What if my parent was under observation, not admitted?
Observation time does not count toward Original Medicare’s three-day inpatient requirement. Ask the hospital and insurer about coverage options, including any applicable Medicare Advantage or waiver rules.
What if Medicare coverage ends before day 100?
Medicare can stop paying once daily skilled care is no longer necessary. The 100 days are a maximum, not a guaranteed allotment.
Does Medicare pay for assisted living?
Generally, no. Medicare does not pay for room and board or ongoing custodial assistance in assisted living.
What is the difference between skilled and custodial care?
Skilled care requires professional nursing or therapy services. Custodial care is help with daily activities such as bathing, dressing, eating, or supervision when skilled treatment is not needed.
Can the nursing home take my parent’s house?
A nursing facility does not simply take the house. However, a home’s treatment under Medicaid depends on the circumstances, including whether a spouse or other protected person lives there. Estate recovery rules can also apply. Get advice before selling or transferring the property.
Do we need to spend everything before Medicaid?
No. Medicaid applies resource limits and specific rules; some assets receive different treatment, and spouses have protections. Do not assume every asset must be spent or transferred.
What does the healthy spouse live on?
Maryland’s spousal-impoverishment rules can protect resources and, in some situations, allow an income allocation for the spouse at home. The amount depends on the couple’s circumstances and current rules.
Can the nursing home make me pay personally?
A nursing home generally cannot require you to guarantee payment from your own funds as a condition of admission. Read any agreement carefully and do not sign a personal-guarantee provision without understanding it.
When should we call an elder law attorney?
Call before transferring assets, making large payments, or assuming your parent must spend everything. If your parent is already hospitalized or in rehab, acting early helps preserve options.
If your parent is in the hospital or rehab now, contact Amenta Law Firm before making transfers or spending down assets. Timing matters, and Maryland Medicaid eligibility depends on the facts of each case. Rules, limits, and costs change. This article provides general information, not individualized legal advice.