In 2026, Original Medicare covers up to 100 days of skilled nursing facility (SNF) care per benefit period, but only after a 3-day inpatient hospital stay. That coverage lasts only while you still need daily skilled care: days 1 through 20 cost you nothing after the Part A hospital deductible, days 21 through 100 carry a coinsurance of $217 a day, and after day 100 Medicare pays nothing.

This guide pays special attention to the situation that matters most for a Georgia family: what happens when you have both Medicare and Georgia Medicaid, or are heading toward Medicaid. That is where the coinsurance, the 3-day rule, and the day-100 cliff all get handled differently.

What Medicare's Skilled Nursing Facility Benefit Covers in Georgia

Medicare's skilled nursing facility benefit is a Part A entitlement for short-term, post-acute skilled care, not for a long-term nursing home stay. To use it, three things must all be true: you had a qualifying inpatient hospital stay of at least 3 consecutive days, you enter a Medicare-certified SNF for care related to that stay, and you need skilled services on a daily basis. When those conditions are met, Medicare covers up to 100 days in each benefit period on this cost ladder.

Days in the stay What Medicare pays What you pay
Days 1 through 20 100% of the approved amount $0 per day (after the $1,736 Part A deductible)
Days 21 through 100 The approved amount minus coinsurance $217 per day
Day 101 and beyond Nothing The full daily rate

Across all 80 days that is about $17,360 out of pocket if nothing else covers it., Who absorbs that depends on what other coverage you have.

The benefit period (not a calendar year)

The 100 days are counted per benefit period, not per year. A benefit period begins the day you are admitted to a hospital or SNF as an inpatient and ends only after 60 days in a row with no inpatient hospital care and no skilled care in a SNF. After that 60-day break, a new benefit period begins with a fresh 100-day SNF allowance. The clock can run without leaving the building: dropping from skilled to custodial care can start a new period.

Many people believe they get 100 SNF days every year. They do not. More than one benefit period can fall in a calendar year, each with its own Part A deductible, but a new one starts only after that 60-day break. Exhaust the 100 days and get re-hospitalized a month later and you do not get a fresh 100, which is usually the moment a family turns to Georgia Medicaid long-term care rather than waiting.

The 3-Day Qualifying Hospital Stay and the Observation Trap

This is the requirement that trips up many Georgia families. Medicare covers SNF care only after you have been a hospital inpatient for at least 3 consecutive days, counting the admission day but not the discharge day.

The trap is observation status: it is billed as an outpatient hospital service even when you spend several nights in a hospital bed, so those nights do not count. A patient who spends three midnights in observation and is then sent to a SNF has no qualifying stay, and the SNF claim is denied.

Two protections exist. Under the Two-Midnight Rule, inpatient admission is generally appropriate when the physician expects care to span at least two midnights. And a hospital must give you a Medicare Outpatient Observation Notice (MOON) once you are an outpatient under observation for more than 24 hours, no later than 36 hours after observation begins, so you learn your status while you can still question it.

If you are in Original Medicare and your status is switched from inpatient to outpatient during the stay, you may be able to appeal, a right CMS created for Original Medicare beneficiaries after the class-action case Alexander v. Azar. While you are still in the hospital, the switch triggers a prospective "fast" appeal: since February 14, 2025 the hospital must give you a Medicare Change of Status Notice (CMS-10868), and you or your representative can request the appeal through Georgia's BFCC-QIO. The separate retrospective track for past stays closed to new filings on January 2, 2026; later requests are denied as untimely absent good cause. A successful appeal restores the qualifying stay and the SNF coverage, and the SNF must refund what you paid, generally within 60 days of the decision. GeorgiaCares helps with this free.

Does Improvement Matter? The Jimmo Standard

A SNF cannot cut off your Medicare coverage simply because you have stopped improving. Under the Jimmo v. Sebelius settlement, Medicare coverage of skilled nursing and skilled therapy turns on your need for skilled care, not on whether you are expected to get better. Skilled care to maintain your current condition, or to prevent or slow a decline, is covered when a professional's skills are required to deliver it safely.

The same Jimmo maintenance standard applies across skilled nursing facility, home health, and outpatient therapy care, and it matters most for Georgians with chronic conditions such as Parkinson's disease, multiple sclerosis, or the lingering deficits after a stroke. Jimmo does not suspend the rest of the rules, though: the care must still be reasonable and necessary, and the 3-day qualifying stay still applies. For a fuller walkthrough, see our guide to the Jimmo settlement and maintenance therapy in Georgia.

Who Pays the $217-a-Day Coinsurance if You Have Medicaid?

For most Georgians in Original Medicare, days 21 through 100 mean paying $217 a day out of pocket unless something else covers it. Two things commonly do.

A Medicare Supplement (Medigap) policy can pay the SNF coinsurance, but that depends on which plan letter you bought. Plan G pays the skilled nursing facility care coinsurance in full, which is why a Georgian with Plan G rarely sees a SNF bill for days 21 through 100. Because Medigap is standardized by letter, every policy sold under the same letter carries the same basic benefits whichever insurer sold it, so check your own letter before assuming the SNF coinsurance is covered.

The bigger story for dual eligibles is the Medicare Savings Program. If you qualify as a Qualified Medicare Beneficiary (QMB) through Georgia Medicaid, QMB pays your Part A and Part B premiums and all Medicare cost-sharing, meaning deductibles, coinsurance, and copays, which is what picks up the SNF coinsurance. Federal law also bars a provider from balance-billing a QMB enrollee for that cost-sharing. In 2026, Georgia applies the federal QMB limits: monthly income up to $1,350 for an individual or $1,824 for a couple, with a resource limit of $9,950 for an individual and $14,910 for a couple. The Specified Low-Income Medicare Beneficiary (SLMB) program covers income up to $1,616 individual or $2,184 couple, and the Qualifying Individual (QI) program up to $1,816 individual or $2,455 couple, though SLMB and QI pay only the Part B premium, not the SNF coinsurance.

Georgia processes these through the Division of Family and Children Services; apply via Georgia Gateway or by calling 1-877-423-4746. If you may be close to the limits, the Georgia Medicare Savings Programs guide walks through how to apply. A QMB approval is what turns that $217-a-day exposure into $0.

If your Medicare comes through a Medicare Advantage plan, the math changes again. MA plans, including the Dual Eligible Special Needs Plans (D-SNPs) built for people with both Medicare and Medicaid, must cover every medically necessary Part A and Part B service, but they set their own cost-sharing rather than the standard $217-a-day schedule, most require in-network providers, and they may require prior authorization for a SNF admission. That network rule has a floor: emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network. QMB cost-sharing protection still applies to you inside a plan, but the plan sets the network and approval terms, so confirm its SNF cost-sharing and preferred facilities before day 21.

What Happens at Day 100: The Georgia Medicaid Handoff

Medicare's SNF benefit ends at day 100, or earlier if you no longer need daily skilled care. If the need is now custodial, Medicare does not cover it, and for many Georgia families the next payer is Georgia Medicaid long-term care.

Georgia Medicaid can pay for a nursing facility stay if the person meets both a functional and a financial test. Functionally, they must need a Nursing Facility Level of Care, determined through the Georgia Department of Community Health. Financially, Georgia is an income-cap state: the institutional Medicaid income limit is set at 300% of the federal Supplemental Security Income benefit rate, which for 2026 is $2,982 a month for an individual and $5,964 for a couple, and the asset limit is $2,000 for an individual and $3,000 for a couple.

An applicant whose income is at or above that cap can still qualify by sheltering the excess in an irrevocable Qualified Income Trust, known in Georgia as a Miller Trust. Georgia requires that the trust be irrevocable and that whatever remains at the applicant's death go to the Department of Community Health, up to what Medicaid spent on their care.

Once approved, the resident keeps a small monthly Personal Needs Allowance and contributes the rest of their income toward the cost of care as their patient liability. In Georgia, the nursing-facility Personal Needs Allowance is $70 a month, the figure DFCS has carried since July 2019 and still shows for 2026. A separate $90 allowance applies to a VA pensioner or surviving spouse in a nursing home who has no dependents, but it is not a windfall: the VA check for those residents is reduced to the amount of the allowance regardless of their other income. A VA pensioner who does have dependents keeps the same $70.

The $70 is not the only thing carved out before the rest goes to the facility. Federal post-eligibility rules also require deductions for a monthly maintenance needs allowance for a spouse still at home, allowances for dependents or family, and health-insurance premiums including Medicare premiums, deductibles, and coinsurance. So a married applicant whose spouse remains in the community does not hand over everything above $70; run the actual patient-liability budget with DFCS rather than assuming. After the resident's death, Georgia Medicaid may seek to recover the cost of that care from their estate, subject to exemptions; see Georgia Medicaid estate recovery.

Because approval takes time, the handoff has to be planned before day 100, not on it.

1
Step 1

Start the application 30 to 45 days before day 100

File early enough that an approval is in place by day 101 and there is no gap.

2
Step 2

Confirm the level-of-care determination

Make sure the Nursing Facility Level of Care assessment is documented; Medicaid requires it on top of the financial test.

3
Step 3

Complete the pre-admission screening

A Level I screen is usually enough when there is no mental illness or intellectual disability.

4
Step 4

Gather the financial documentation

Assemble income and asset records, and set up a Qualified Income Trust in advance if gross monthly income is at or above the $2,982 cap.

5
Step 5

Confirm the facility takes Medicaid

Check that the SNF is Medicaid-certified so the resident keeps the same bed after Medicare ends. If not, plan a transfer.

Your Georgia Medicare Skilled Nursing Facility Benefit Is Not a Medicaid Nursing Home

The words sound the same, which is exactly why families conflate them. A Medicare skilled nursing facility stay is short-term skilled care after a hospital admission. A Georgia Medicaid nursing home stay is long-term custodial care: routine help with bathing, dressing, toileting, and medication once the skilled need is gone, which Medicare will not pay for at all. The same physical building often holds both kinds of bed, so the difference is not the place, it is who is paying and why.

3-Day Stay Waivers: D-SNPs and ACOs in Georgia

The 3-day inpatient requirement is not absolute. Two arrangements can waive it, and both are relevant to Georgia dual eligibles.

Some Medicare Advantage plans, including Dual Eligible Special Needs Plans (D-SNPs), the Special Needs Plan type for people with both Medicare and Medicaid, waive the 3-day qualifying stay and can authorize a SNF admission directly. Waiving it is a plan choice, not a feature every plan carries, so read your own plan's benefit documents rather than assume.

Which D-SNPs are available differs from county to county, because insurers decide where they do business. Georgia's Department of Community Health announced a moratorium on contracting with any new D-SNPs starting August 1, 2025, to comply with the federal D-SNP integration requirements at 42 CFR 422.514(h), and said further updates would follow once the future state has been redefined. To see which D-SNPs are actually offered in your county for the current plan year, use the Medicare Plan Finder or call GeorgiaCares; our Georgia D-SNP guide explains how these plans work.

Separately, providers in a Medicare Shared Savings Program Accountable Care Organization can hold a SNF 3-Day Rule Waiver, letting an assigned patient enter a partner SNF without the inpatient stay. Standard Medicare SNF cost-sharing still applies in both cases.

Worked Examples

The scenarios below are hypothetical and illustrative. Every situation is different; confirm your own coverage with the SNF, your plan, and Georgia Medicaid.

Example 1: A qualifying stay and a Medigap plan

Margaret, 78, in Atlanta, fractures her hip, has surgery, and stays four consecutive inpatient midnights, so her 3-day qualifying stay is met. She transfers to a SNF needing daily physical therapy and skilled nursing for her surgical site. Medicare covers days 1 through 20 in full. For days 21 through 30 the coinsurance is $217 a day, but her Medigap Plan G pays it, so she owes nothing. She goes home on day 30 with 70 SNF days still available in this benefit period.

Example 2: Observation status denies the benefit

Robert, 82, in Savannah, spends two nights under observation for a compression fracture, then one inpatient night after a procedure. His inpatient stay is a single midnight, so his qualifying stay is not met even though he was in the hospital three days, and the SNF he needs will not be Medicare-covered. His family requests the MOON documentation and calls GeorgiaCares while they weigh private pay against a Medicaid application.

Example 3: Running out at day 100 and pivoting to Georgia Medicaid

Charles, 80, in Augusta, has a stroke and enters a SNF after a qualifying hospital stay. His recovery is slow and he still needs facility care as day 100 approaches. At day 75, the SNF social worker starts his Georgia Medicaid long-term-care application. His income is comfortably below the $2,982 cap and his assets are under $2,000, so he is approved effective day 101. He is widowed with no dependents, so nothing is deducted for a spouse at home: he keeps the $70 monthly Personal Needs Allowance and his Medicare premiums, and the rest of his income goes toward care. Because his facility is Medicaid-certified, he stays in the same bed.,

Discharge Rights and Fast Appeals

Before a SNF ends your Medicare-covered stay it must give you a Notice of Medicare Non-Coverage at least 2 days before covered services end. If you disagree, ask your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for an expedited review, following the notice's instructions no later than noon the day before the termination date printed on it. In Georgia the BFCC-QIO is Acentra Health (formerly Kepro), at 1-888-317-0751; you can confirm it through the CMS BFCC-QIO page or 1-800-MEDICARE. If the review upholds the discharge, the standard Medicare appeals levels remain open.

Statutory and Regulatory Reference

The Medicare SNF benefit rests on the Social Security Act: Section 1812(a)(2) establishes post-hospital extended care as a Part A benefit, Section 1861(i) defines extended care services and the qualifying-stay requirement, and Section 1812(b)(2) sets the 100-day limit per benefit period. Coverage rules are codified at 42 CFR 409.20 through 409.36; facility conditions of participation at 42 CFR Part 483. Custodial care that outlasts the benefit falls to Medicaid.

Frequently Asked Questions

Does Medicare pay for a nursing home in Georgia?

Only short-term skilled care: up to 100 days per benefit period, after a qualifying 3-day inpatient stay, and only while daily skilled care is needed. It does not pay for long-term custodial nursing home care, which falls to Georgia Medicaid, private pay, long-term care insurance, or VA benefits.

How much does Medicare SNF care cost in Georgia in 2026?

Days 1 through 20 cost nothing after the Part A hospital deductible. Days 21 through 100 carry a coinsurance of $217 a day in 2026, about $17,360 across all 80 days. After day 100 you pay the full daily rate. A Medigap plan whose letter covers the SNF coinsurance, or QMB status through Georgia Medicaid, can absorb it.

Does time in observation count toward the 3-day hospital stay?

No. Observation is an outpatient service, so those nights do not count even if you stayed in a hospital bed overnight. Only inpatient midnights count, and this is a common reason a SNF claim is denied.

Can a SNF discharge me because I stopped improving?

No. Under the Jimmo v. Sebelius settlement, Medicare coverage depends on your need for skilled care, not on your potential to improve. Skilled care to maintain your condition or slow a decline is covered when a professional's skills are required.

As a Georgia dual eligible, do I pay the $217-a-day coinsurance?

Generally no, if you have QMB. Qualified Medicare Beneficiary status pays all Medicare cost-sharing, which includes the days 21 through 100 coinsurance, and federal law bars the facility from balance-billing you for it, so a QMB usually owes $0 for the same stay that would cost a Medicare-only neighbor $217 a day. SLMB and QI, the two higher-income Medicare Savings Programs, pay only the Part B premium and do not cover the SNF coinsurance.

Does Medigap cover the SNF coinsurance?

It depends on your plan letter. Plan G pays the skilled nursing facility care coinsurance in full, so a Medicare-only Georgian with Plan G typically owes nothing for it. Because Medigap benefits are standardized by letter, every policy sold under the same letter carries the same basic benefits, so check the letter on your own policy rather than assume all Medigap covers this.

Does Medicare Advantage cover SNF care in Georgia?

Yes, but on the plan's terms. A Medicare Advantage plan must cover every medically necessary Part A and Part B service, but most generally require in-network providers, may require prior authorization, and set their own cost-sharing instead of the standard schedule. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network. Some plans, including some D-SNPs, also waive the 3-day rule. Confirm the SNF is in network and check cost-sharing before a transfer.

How does a Medicare benefit period reset?

After 60 days in a row with no inpatient hospital care and no skilled SNF care, a new benefit period begins with a fresh 100-day SNF allowance for the next qualifying stay. More than one benefit period can fall in a single calendar year, each carrying its own Part A deductible.

What happens when my 100 Medicare days run out?

If you still need facility care, Medicare stops paying at day 100 and long-term coverage typically shifts to Georgia Medicaid long-term care. Start that application 30 to 45 days before day 100, because Georgia's income cap, asset limits, and any Qualified Income Trust take time to arrange. For 2026 that cap is $2,982 a month for an individual and $5,964 for a couple, the figure Georgia's own Appendix A1 chart carries.

Where to Get Help in Georgia

GeorgiaCares (State Health Insurance Assistance Program) Free Medicare counseling, including observation-status and SNF questions. 1-866-552-4464https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship aging.georgia.gov/georgia-ship
Georgia Department of Community Health, Medicaid Member Services Medicaid long-term care and dual-eligible coordination. 1-866-211-0950https://www.gabar.org/about-the-bar/contact-us dch.georgia.gov
Georgia Division of Family and Children Services Applications for MSPs and Medicaid long-term care. 1-877-423-4746https://dhs.georgia.gov/contact dfcs.georgia.gov
Medicare Coverage rules, plan questions, and your current BFCC-QIO. 1-800-633-4227https://www.medicare.gov/talk-to-someone medicare.gov SNF coverage
Georgia Long-Term Care Ombudsman Run by the Division of Aging Services; advocates for nursing home residents and investigates complaints. aging.georgia.gov Ombudsman
Atlanta Legal Aid Senior Citizens Law Project Coverage denials, appeals, and Medicaid planning. 404-377-0701 atlantalegalaid.org

Learn More

MedicaidThe Medicare 3-Day Qualifying Hospital StayGeorgia's Medicare 3-day qualifying hospital stay rule explained: how days count, why observation doesn't, the 30-day SNF window, waivers, and appeal rights. MedicaidMedicare Observation Status vs. InpatientGeorgia Medicare observation status vs inpatient: observation stays don't count toward the SNF 3-day qualifying stay and bill under Part B, not Part A. MedicaidJimmo v. Sebelius and Maintenance TherapyHow the Jimmo v. Sebelius settlement requires Medicare to cover skilled maintenance therapy in Georgia without proof of improvement, plus appeals guidance. MedicaidGeorgia Medicaid Long-Term CareGeorgia Medicaid long-term care in 2026: nursing facility coverage, four HCBS waivers (EDWP with CCSP and SOURCE, ICWP, NOW, COMP), PACE, and how to apply. MedicaidGeorgia Medicare Savings ProgramsGeorgia Medicare Savings Programs in 2026: how QMB, SLMB, QI, and QDWI pay Medicare premiums and cost-sharing, the income and asset limits, and how to apply.

Find personalized help navigating Medicare SNF coverage and the Medicaid handoff in Georgia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.