Skilled nursing facility (SNF) residents who leave their SNF to go home or to move into another SNF do not lose their Medicare coverage. If they go home, they can use Medicare for home health care, outpatient services, and so on. If they go home for some days and then return to a SNF, or if they go directly to a different SNF, they can resume their Part A coverage for SNF care if they are admitted to a SNF within 30 days of their discharge from the acute care hospital. The Medicare Benefit Policy Manual, Chapter 8, section 20.2.3, confirms Medicare coverage for a resident who “leaves a SNF and is readmitted to the same or any other participating SNF for further covered care within 30 days after the day of discharge.”
Residents aren’t prisoners – they have the right to leave their nursing home.
This Alert stems from two calls in two days reporting that SNFs have told residents that if they leave – “against medical advice” or “before 20 days” – they will lose Medicare coverage. The implied threat is that the residents will have to pay out-of-pocket for these days in the SNF. These statements are not true. SNFs bill Medicare on a daily basis. For example, if a resident leaves a SNF after seven days, the SNF can bill Medicare for those seven days so long as it provided the resident with Medicare-covered daily skilled care (skilled nursing care for all seven days or skilled rehabilitation services for five days). SNFs’ interest in keeping residents in Part A stays is understandable. Medicare is the highest payer for care. The Centers for Medicare & Medicaid Services’ annual update to Medicare reimbursement rates, 90 Fed. Reg. 38310, 37324-37325 (Tables 9, 10, and 11) (Aug. 4, 2025) shows that per day rates can now exceed $1000 per day. The Medicare Payment Advisory Commission (MedPAC) reports in its March 2025 Report to the Congress: Medicare Payment Policy that for the 24th consecutive year, Medicare margins were 10% or higher, and, in 2022, they were 22%.
December 17, 2025 – T. Edelman