What to Do When Medicare Ends Nursing Home Coverage
The noon-before deadline for a fast appeal of skilled nursing coverage ending.
Start here
Use the Notice of Medicare Non-Coverage and request a fast appeal no later than noon the day before the termination date. Ask for the Detailed Explanation of Non-Coverage and identify the skilled care still required.
What to have in front of you
- The notice, bill, decision, or discharge paperwork connected to the problem
- The person’s full name, date of birth, address, insurance information, and identification
- A short timeline with dates, names, phone calls, and what changed
- Copies of medical, school, financial, or care records that directly support the request
What to say when someone answers
“I received a Notice of Medicare Non-Coverage. I am requesting a fast appeal because the resident still needs skilled care for these specific reasons.”
Small but useful: Write down the person’s name, the date, the exact next step, and when you should call again.
Do this in order
- 1
Photograph the notice and calendar the noon deadline.
- 2
Call the QIO, get a case number, and tell the facility the appeal was filed.
- 3
Request therapy, nursing, wound, medication, and progress records plus the Detailed Explanation of Non-Coverage.
- 4
Explain why skilled professionals are still needed to improve, maintain, or prevent deterioration.
What happens next
The QIO reviews the record and issues a rapid decision. The notice explains financial responsibility during and after review.
If they say “we’ll put you on the list”
If the appeal is denied, ask about expedited reconsideration and start Medicaid or private-pay planning immediately. Coverage ending is not automatically a lawful facility discharge.
Official sources
Checked August 5, 2026. Programs, hours, funding, and enrollment lists can change. Confirm details directly before relying on them.