Improving Access to Medicare Coverage Act of 2025
Congress Proposes Bill to Expand Medicare Coverage for Nursing Home Care After Hospital Stays
Stalled
No legislative action in over 90 days.
Legislative Progress
Key Points
- Medicare usually only pays for a stay in a skilled nursing facility or rehab center if a patient was first admitted to a hospital as an "inpatient" for at least three days. This bill would change the law so that time spent in "observation status" also counts toward those three days.
- Many seniors are currently surprised by large bills because hospitals often keep patients for several days under "observation" without officially admitting them. Because observation is considered outpatient care, Medicare currently won't pay for the nursing home care that follows.
- If passed, this change would take effect on January 1, 2026. It would help ensure that patients receive the Medicare benefits they expect after a long hospital stay, regardless of how the hospital categorized their time there.
- The bill also includes a way for people who recently finished their care to appeal for coverage. If they were denied coverage in the past because of the 3-day rule, they may be able to get their costs covered if they file an appeal within 90 days of the bill passing.
Impact Analysis
Personal Impact
Programs
This bill amends the Social Security Act (Title XVIII, which governs Medicare). While it doesn't change cash Social Security benefits, many Social Security recipients are also Medicare beneficiaries. Seniors on Social Security who need hospital and post-hospital nursing care would benefit from the expanded coverage rules, since observation days would now count toward the 3-day inpatient requirement for skilled nursing facility coverage.
Disabilities
Milestones
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in House
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
6 articles
Lawmakers Push to Let Observation Stays Count for Medicare Nursing Home Coverage
A bipartisan group of House lawmakers has reintroduced the Improving Access to Medicare Coverage Act of 2025. The bill would update Medicare's 60-year-old three-day requirement by counting time spent in the hospital under observation status toward the threshold for nursing home coverage.
3-Day Hospital Stay Rule for Nursing Homes Fails to Improve Outcomes, Cut Costs, as Researchers Question 'Rigid' Thresholds
A study in JAMA Internal Medicine found that reinstating the Medicare 3-day rule led to longer hospital stays without reducing nursing home use. Advocates point to the Improving Access to Medicare Coverage Act of 2025 as a solution to count observation days toward this requirement.
What is the 3-day rule for Medicare and how does it impact your coverage?
The Medicare 3-day rule requires a three-day inpatient stay for nursing home coverage. The rule is increasingly problematic due to 'observation status,' where hospitals treat patients as outpatients, leaving seniors with massive bills for follow-up care that Medicare refuses to cover.
Source Information
Document Type
Congressional Bill
Official Title
Improving Access to Medicare Coverage Act of 2025
Data Sources
Sponsor
Cosponsors
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