"As we understood it, we thought he had 100 days of Skilled Nursing covered," an adult child wrote on a Medicare forum, partway through a parent's rehab stay. The first reply got straight to it: "Up to doesn't mean someone gets 100 days."
That exchange is the whole chapter. Many families walk into a nursing home believing Medicare has promised them 100 days. The admissions office knows the typical stay is about a third of that, and that the bill changes on day 21. Somewhere between the hospital and the second week, someone explains the difference. The nursing home that explains it first, in its ads and on its landing page, is the one families trust enough to call.
Families Hear 100 Days. The Average Medicare-Covered Rehab Stay Ran 30.7 in 2024.
The numbers come from MedPAC, the commission that advises Congress on Medicare. In 2024, the average Medicare-covered skilled nursing stay lasted 30.7 days, up from 26.1 in 2019. It's a long way from 100.
The shape of the benefit explains part of it. Medicare pays in full for the first 20 days. From day 21 through day 100, the patient owes a daily coinsurance, $217 a day in 2026. Across 80 days that adds up to as much as $17,360 in one benefit period, before any supplemental coverage. MedPAC even found a small bump in the data: more stays end on day 20, 3.6%, than on day 19 or day 21, about 2.5% each. Day 20 is the last day before the family starts paying.
Coverage also depends on need, not the calendar. Medicare covers the stay while the patient needs skilled care every day. When the care team decides that daily skilled need has ended, coverage ends too, whether it's day 12 or day 60.
Families feel that as a surprise. In the Reddit threads we read, 51 posts talked about a "plateau," a patient "not progressing," or being cut off. Among our example-market reviews, rehab families filed 15 complaints about billing, and many were about the moment coverage stopped. "Starting tomorrow my copay is over $200 a day," one rehab patient wrote.
Medicare Doesn't Require a Patient to Keep Getting Better
One myth makes the surprise worse. Families often believe Medicare stops paying the moment a patient stops improving, and the word they hear is "plateau." "They said she has 'plateaued' because she does not give her full attention during therapy," one caregiver wrote.
The federal rule says otherwise. Under 42 CFR 409.32(c), a patient's restoration potential "is not the deciding factor" in whether skilled services are needed. Even when full recovery isn't possible, skilled care that prevents decline or preserves what the patient can still do can qualify. Medicare's own site describes covered skilled care as care "to improve or maintain your current condition, or to prevent or delay it from getting worse."
That doesn't mean every plateaued patient stays covered. The test is still whether daily skilled care is needed. But ads and landing pages shouldn't repeat the myth. Copy like "Rehab for patients ready to recover" implies a standard Medicare doesn't use, and it can set up exactly the argument the family will have with you in week three.
Long-Term Care Runs on Medicaid and Savings, and the Look-Back Is Five Years
The long-term side of the building has a different money story. Medicare generally doesn't cover custodial care, which is what most long-term residents receive. Federal rules exclude it outright, and Medicare's own page on long-term care is marked "Not Covered."
So Medicaid carries it. According to KFF's analysis of 2025 federal data, Medicaid is the primary payer for 63% of nursing home residents nationally, and 64% in Pennsylvania, our example market's state. Medicare covers 14%, mostly short-term rehab patients on any given day. The rest pay from savings or other sources.
Families find this out fast, and often painfully. Reddit carried 146 mentions of Medicaid in the threads we read, plus 18 about spending assets down and 13 about the look-back. The look-back is real: Medicaid reviews asset transfers made in the 60 months, five years, before an application. Asset limits, spousal protections and the application process all vary by state.
For an ad, the lesson is restraint. "Medicaid Accepted" is useful on a long-term ad if you have Medicaid beds to fill (Chapter 5 covered that decision). Anything more specific, such as asset limits, protecting the house, or how to qualify, belongs in a conversation with your business office or an elder law attorney, not in an ad or a landing page promise.
The Ad That Explains Medicare's 100-Day Rule Is the One Families Trust
Here's what honest payer copy looks like on each side of the building.
On the rehab side, say what Medicare actually does. "Medicare Rehab: Days 1-20 Covered" is true for a Traditional Medicare patient who qualifies, and it's more useful than "100 Days Covered," which isn't. A description can carry the rest: "Medicare covers qualifying rehab after a hospital stay. Our business office explains your days before you arrive." Medicare Advantage plans work differently. They may charge copays in the first 20 days, and they can require prior authorization before a stay. Since January 2026, those plans must decide standard prior authorization requests within 7 calendar days and urgent ones within 72 hours, but the answer still arrives plan by plan. Keep plan-specific promises out of the ad and on the phone.
On the landing page, give coverage its own plain-English section: what Medicare covers, what days 21 through 100 cost, what happens if coverage ends, and who at your building answers those questions. Put the business office's direct number there, not just the admissions line. A family that understands the rules before admission is a family that doesn't write the review about surprise charges.
The best offer in this category isn't a discount. It's information. A free, one-page guide to Medicare rehab coverage, or a short checklist of questions to ask before discharge, gives families something they genuinely need and gives your ads a reason to click that we didn't see in any of the 134 local nursing home ads from Chapter 8. It's also the offer least likely to run into the rules in the next section.
Gift Cards, Waived Copays and Free Weeks Can Break Federal Law
Nursing homes operate under federal fraud and abuse laws that most small businesses never think about, and several common ad offers run straight into them.
The Anti-Kickback Statute makes it a felony to offer anything of value to induce referrals of Medicare or Medicaid business. A separate civil penalty, the beneficiary inducement rule, applies to offering Medicare or Medicaid beneficiaries anything likely to influence which provider they choose, at up to $20,000 per item or service under the statute. That law defines "remuneration" to include waiving coinsurance and deductibles. A nursing home can still forgive a copay for a family that genuinely can't pay it, case by case. What it can't do is put that forgiveness in an ad, because the exception disappears the moment the waiver is advertised.
The federal Office of Inspector General has spelled out how this applies to nursing homes. Its 2024 compliance guidance for nursing facilities lists, as suspect examples, gift cards for enrollees and their families, waiving copayments, and free items like meals or sporting event tickets for hospital discharge planners. It adds that nursing facilities "are expected to compete for consumers through the quality of care and quality of life they provide."
A few practical lines follow from that, as our reading of the rules:
- Never advertise a waived copay. "We cover your days 21-100" is the offer the statute describes.
- No gift cards for tours or inquiries. OIG names gift cards specifically, and cash equivalents never count as small gifts.
- Keep giveaways small. OIG treats gifts worth $15 or less each, and $75 a year per person, as nominal. A branded mug on a tour is fine. A $50 card isn't.
- Don't advertise free clinical services like a free first week without a lawyer's review.
- Nothing of value for discharge planners. The liaison from Chapter 14 brings information, not lunch for the department.
Have counsel review any offer before it goes into an ad. The penalties are real, and "everyone does it" isn't a defense.
Google's Healthcare Policy Doesn't Block a Nursing Home. Its Misrepresentation Rules Can.
Google's healthcare and medicines policy is aimed mostly elsewhere. Its tightest restrictions cover addiction treatment, which requires certification (the reason Chapter 5 kept drug rehab out of the keywords), and prescription drugs. By our reading, a skilled nursing facility's ads don't need special certification to run.
The Google rules that do trip up nursing homes are the general ones. The misrepresentation policy bans unreliable claims, which covers a promise like "100 days covered," and unavailable offers, which covers advertising a bed or a Medicaid admission you can't actually provide (Chapter 8). And Chapter 13 showed how "Medicare Accepted" can mislead when it lands on a long-term care ad. The honest, specific ad is the one that passes both Google's review and the family's.
Next: Hiring Ads That Fill Beds
Chapter 16 closes the guide with recruiting: why a nursing home's hiring ads are part of its admissions strategy, and how Google's employment rules change the targeting.
Every chapter, from tracking through the hospital list and hiring, is on the guide's home page.
On the nursing home accounts we run in Google Ads management, payer copy gets checked against Medicare's own wording before it runs, and no offer goes live without the facility's compliance lead signing off. If you're running your own, read your rehab ads today and look for the number 100.
