Medicare Part A’s Three-Day Rule

By Patricia Barry

Copyright © 2018 by AARP. All rights reserved.

If you’re in the traditional Medicare program, you must spend at least three days in the hospital as an officially admitted patient before Medicare will cover your stay in an approved SNF. This type of facility (most often a nursing home) is where you may go for further care needed after being discharged from the hospital, such as intravenous injections or physical therapy.

The three days must be consecutive. They include the day you’re admitted but not the day you’re discharged because one “day” counts only if you’re in the hospital at midnight. Nor do they include any time you spend in the emergency room. Also — and this point is super-important — you must be an official inpatient during those three days instead of just being held in observation status.

If you haven’t met the three-day inpatient requirement, the SNF staff should tell you that Medicare won’t cover your stay there. You’ll be given an Advance Beneficiary Notice of Non-Coverage (ABN), which you must sign to say you understand you’re responsible for all costs if you do stay.

However, if the SNF fails to give you this warning, and you stay for treatment in the SNF despite not having met the three-day rule, the facility can’t bill Medicare — or you — for your stay.

Note two important exceptions to the three-day rule:

  • It’s not usually applied to people enrolled in Medicare Advantage plans.
  • It affects only coverage in a skilled nursing facility. If you’re discharged from the hospital to another kind of facility for specific ongoing care, such as a rehabilitation hospital, Medicare provides coverage under different rules.