The 'Day 21' Rehab Co-Pay Shock. Why Staying One Day Too Long Costs You $217 a Day

The 'Day 21' Rehab Co-Pay Shock.

You survived the surgery. You spent your required 3 days in the hospital. Now, you are recovering in a Skilled Nursing Facility (SNF) for rehab.

The first few weeks are great. The therapy is helping, the meals are decent, and you haven't paid a dime. You think, "Medicare is wonderful!"

Then, the bill arrives. It’s for thousands of dollars. Why? Because you unknowingly stayed past Day 20.

Here is the critical math of Medicare Part A that hospitals often forget to explain clearly until it is too late.

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1. The 100-Day Rule Breakdown (Official 2026 Rates)

Medicare Part A does cover rehab, but the coverage changes drastically based on your length of stay. Here is the official schedule for 2026:

📅 The Cost Calendar (2026)

• Days 1–20: $0 cost to you. Medicare pays 100% of covered charges.
• Days 21–100: You pay $217.00 per day. (This is the 2026 daily co-insurance rate).
• Days 101+: You pay 100%. Medicare pays nothing.

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2. Do The Math: The Cost of Ignorance

Let's say you are recovering from a hip replacement. You feel "okay" on Day 20, but you decide to stay another two weeks just to be safe.

• 14 extra days x $217 = $3,038.

That is a $3,000 bill for two weeks of care that you might have been able to receive at home. If you stay the full allowed time (up to Day 100), your out-of-pocket bill will exceed $17,300.

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3. How to Avoid the Bill

You have three main ways to protect yourself from this "Day 21" financial cliff:

A. Medigap (Supplement) Plans

If you have a Medigap policy (specifically Plan G or Plan N), it pays the $217 daily fee for you. This is one of the biggest financial advantages of Medigap. It turns that potential $17,000 debt into $0.

*Note: Plan A and Plan B generally do NOT cover this SNF co-insurance. Check your policy card.

B. Medicaid

If you have limited income and assets, state Medicaid programs may step in to pay the co-insurance. However, this is not automatic; you must apply and be approved before the bill is due.

C. Watch the Calendar

If you rely solely on Original Medicare (without a supplement), you must be vigilant.

• Ask the facility administrator regularly: "What day number am I on?"
• As you approach Day 20, discuss with your doctor if it is safe to discharge home and switch to "Home Health Care." (Eligible medical home health services are covered at 100% with no daily co-pay).

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4. Warning: Medicare Advantage Plans Are Different

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, the rules above likely do not apply.

Many Advantage plans charge a daily co-pay starting on Day 1 or Day 6, rather than giving you 20 free days. Check your plan's "Summary of Benefits" immediately. You might be accruing debt from the moment you walked in the door.

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Mark Day 20 in Red

Rehab is for recovery, not for resting. The system is designed to push you out quickly.

Mark "Day 20" on your calendar in big red ink. Unless you have a Medigap plan that covers the difference, that date is your strict deadline to make a serious financial decision.