After receiving inpatient care at the hospital for an illness or surgery, a person may need further care under the supervision of trained nurses. In such cases, a doctor may refer them to a skilled nursing facility (SNF).

Medicare will cover temporary care in an SNF if a person meets certain criteria. To qualify for Medicare Part A coverage, an individual needs to have had an inpatient hospital stay of 3 consecutive days before receiving admittance to the SNF. This is called the 3-day rule, or the 3-midnight rule.

The 3-midnight rule gets its name from how Medicare counts days. For a person to meet the requirements of this rule, they need to have 3 consecutive days of inpatient hospital care — not counting observation — before admission to an SNF. This can occur in one or more hospital facilities.

Each midnight a person remains in the hospital is considered 1 day, even if it is only part of a day by other measurements. For example, if a person receives admittance to the hospital at 11:00 p.m. on a Friday, as soon as the clock strikes midnight and it becomes Saturday, it is considered day 1 for Medicare counting purposes.

For this individual to meet the requirements of the 3-midnight rule, they would need to be discharged after 12:00 a.m. on Monday morning — their third midnight.

The time a person may spend in an emergency department or under outpatient observation does not apply to the 3-midnight rule.

In addition to the 3-midnight rule, other factors will determine whether Medicare will cover a person’s stay in an SNF:

  • The admission to a Medicare-certified SNF must occur within 30 days of leaving the hospital.
  • A person’s doctor has to recommend daily care or therapy from skilled nursing staff.
  • Care at the SNF must be for the same condition needing treatment during a person’s in-patient hospital stay.
  • A person must require skilled nursing care to improve their condition or prevent it from worsening.

If a person meets the requirements of the 3-midnight rule before admission to an SNF, Medicare Part A will cover all their costs for the first 20 days in the facility. However, they must first meet the Part A annual deductible of $1,676.

From days 21 to 100, a person will be responsible for paying $209.50 per day. After this, they will need to pay all costs relating to their stay.