Can You Get Medicare Skilled Nursing (Rehab) Care for an Unrelated Injury While on Hospice?

Yes, in some cases. If the injury or illness is unrelated to the terminal illness, Medicare can pay for a skilled nursing facility (SNF) rehab stay under its regular SNF benefit while your loved one stays on hospice for the terminal illness. CMS's hospice manual says a beneficiary can be in a SNF under the SNF benefit for an unrelated condition and receive hospice for the terminal condition at the same time. The catch is that every normal SNF rule still applies, including a qualifying hospital stay, and CMS's own billing manual describes the situation as uncommon.

Why this is possible: what you give up when you elect hospice

When someone elects the Medicare hospice benefit, federal rules (42 CFR 418.24) say they waive Medicare payment for services related to the terminal illness and related conditions, and for services that duplicate hospice care, unless the chosen hospice provides or arranges them (the patient's own attending physician is also excepted). They do not waive coverage for problems that have nothing to do with the terminal illness. In CMS's words, Medicare services for a condition completely unrelated to the terminal condition remain available if the patient is eligible for them.

Medicare.gov puts it the same way: Original Medicare still pays for covered benefits for health problems that aren't part of the terminal illness, and the usual deductibles and coinsurance apply. That is why a hospice patient who breaks a hip, or develops another unrelated condition, is not automatically shut out of Medicare's skilled nursing benefit. For the broader list of what the hospice benefit itself leaves out, see what hospice does not cover.

The SNF benefit's normal rules still apply

Being on hospice does not relax the SNF requirements. According to Medicare.gov, Part A covers a SNF stay only when all of these are true:

• The patient has Part A and has days left in the current benefit period.
• They had a qualifying inpatient hospital stay of at least 3 days in a row, counted from the day they were formally admitted as an inpatient. Time under observation or in the emergency room does not count, even overnight.
• They enter the SNF generally within 30 days of leaving the hospital.
• A doctor or other provider has determined they need daily skilled nursing or therapy.
• The care is for a condition treated during the hospital stay (or a new condition that started during the SNF stay), in a Medicare-certified SNF.

In the broken-hip example, that usually means the fracture is treated during a hospital admission of at least three inpatient days, and a doctor orders daily rehab afterward. A fall that is checked in the ER and sent home, or a short observation stay, does not open the SNF benefit, however much therapy the person needs.

2026 SNF cost per benefit period	What the patient pays
Days 1–20	$0 per day, after the $1,736 Part A deductible (which may already be paid if there was a hospital stay in the same benefit period)
Days 21–100	$217 per day
Day 101 and beyond	All costs

While the SNF benefit is paying, it covers a semi-private room and meals along with skilled nursing and therapy. That is different from ordinary nursing-home residence on hospice, where Medicare does not pay the room; see does Medicare pay for the nursing home if you're on hospice.

The deciding question: is it "related"?

Whether the SNF benefit can be used turns on whether the injury is related to the terminal illness, and the hospice makes that call for each patient. If the hospice decides the condition is related, its care belongs to the hospice benefit, and the SNF benefit cannot be used for it while the patient stays on hospice.

For hospice elections that began on or after October 1, 2026, the hospice must give every patient a written addendum to the election statement within the first 5 days, titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs." It lists the conditions the hospice has decided are unrelated, the items, services, and drugs it will not cover because of that, and a plain-language clinical explanation of why. If the plan of care changes in a way that affects those decisions, the hospice must update the addendum within 3 days. Signing it only confirms you received it, not that you agree. The addendum must also tell you that immediate advocacy is available through the Medicare Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) if you disagree with the hospice's determination.

What happens to hospice during the rehab stay

CMS's claims manual lists this exact scenario, a patient in a SNF under the Medicare SNF benefit for an unrelated condition while receiving hospice routine home care, as a recognized but uncommon arrangement. The hospice keeps caring for the terminal illness; the SNF bills regular Medicare for the unrelated rehab.

One practical risk: if the SNF has no contract with the hospice and the hospice cannot reach the patient there, CMS lists that as an example of a situation that can lead to discharge from hospice. CMS expects the hospice to weigh how long the patient will be in the facility and how it affects the plan of care before deciding discharge is appropriate. Before a transfer, ask whether the rehab facility works with your hospice. For how facilities and hospices share care, see can a nursing home discharge a resident who is on hospice.

If the rehab is for the terminal illness

If the hospice decides the injury is related, there are two routes. First, the hospice must make physical therapy, occupational therapy, and speech-language pathology available (42 CFR 418.72), so ask what therapy it can provide under the plan of care. Second, the patient can revoke hospice at any time (42 CFR 418.28). Revoking restores the Medicare coverage that was waived, and the patient can elect hospice again later if eligible. The remaining days of that hospice election period are given up. See can you leave hospice and resume treatment.

Frequently asked questions

Does a fall or fracture automatically count as unrelated?

No. The hospice decides case by case whether a condition is related to the terminal illness and related conditions. Ask for the decision in writing; for elections on or after October 1, 2026, it belongs on the election statement addendum.

My mother already lives in the nursing home. Does that count as a SNF stay?

Not by itself. Living in a nursing home is not the same as a Medicare-covered SNF stay. She would still need a qualifying 3-day inpatient hospital stay and a daily skilled need for an unrelated condition.

What if she is in a Medicare Advantage plan?

Once a Medicare Advantage member elects hospice, CMS says care unrelated to the terminal illness is paid through Original Medicare (fee-for-service) for as long as the election lasts. The plan still provides any extra benefits it offers, such as dental or vision.

If a hospital stay happens under hospice and we then revoke, does it count toward SNF eligibility?

CMS's manual says that if a hospice patient receives general inpatient care in a hospital for 3 days or more and then revokes hospice, that stay still qualifies the beneficiary for covered SNF services.

What to do next

If your loved one on hospice has a new injury, call the hospice first and ask two questions: do you consider this related to the terminal illness, and does the rehab facility you're considering work with you? Then confirm with the hospital discharge planner that the stay is an inpatient admission of at least three days. If you are still choosing a hospice, compare hospices near you and ask each one how it handles unrelated conditions.