Key Takeaways
- Medicare Part A covers skilled nursing facility care for up to 100 days per benefit period.
- You must have a qualifying 3-day inpatient hospital stay and your doctor must determine you need daily skilled care to be eligible.
- Medicare covers a semi-private room, meals, skilled nursing care, therapy services, and more in a Medicare-certified SNF.
- As of 2024, you pay $0 for the first 20 days, then $204 per day for days 21-100, and the full cost after 100 days.
Overview
Medicare Part A skilled nursing benefits are designed to help you recover, maintain, or prevent the worsening of your condition.
That means Medicare will help cover skilled nursing facility (SNF) care for a specific medical condition that is expected to improve. However, Medicare Part A does not cover long-term custodial care for chronic conditions, such as Alzheimer’s Disease or dementia.
Also to be eligible for Medicare SNF benefits, you must have had a qualifying hospitalization.
Here’s what you need to know about how your Medicare benefits help you pay for skilled nursing care, and what you need to do to protect yourself against the high potential costs of nursing facility care.
LEARN MORE: What You Need To Know About Long Term Care Insurance
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What Does Medicare Part A Cover?
Medicare Part A covers skilled nursing facility care for up to 100 days per benefit period. Not per year!
When you’re eligible, Medicare pays for your stay in a skilled nursing facility (SNF). You need to meet certain conditions to get this benefit:
- You must be enrolled in Medicare Part A.
- You must have days left in your benefit period.
- You must have just had a qualifying hospital stay of at least three days.
NOTE: You must be formally admitted to a hospital for at least three days to qualify for skilled nursing facility benefits. An overnight hospital stay in “observational” status does not count. A doctor needs to admit you, and you need to have paperwork proving it. Otherwise, Medicare officials may deny you the coverage, and you’ll have to pay all nursing home costs out of your own resources.
Your Rehab/SNF Out-of-Pocket Costs Under Medicare
You won’t pay anything for the first 20 days at an SNF.
But from day 21 to day 100, there’s a daily copayment of $204.
After 100 days, you’re responsible for the total cost of your care1.
Unless you have other coverage, such as Medigap, Medicare Advantage, Medicaid, or the Medi-Share 65+ health sharing plan, which also shares skilled nursing facility costs, you must pay these costs out of pocket.
For most people, a daily coinsurance amount of $204, on top of the Part A deductible they just paid for their qualifying hospitalization, would be a significant financial burden.
Medigap and Nursing Facility Benefits
Most people should consider purchasing a Medigap plan, a Medicare Advantage plan, or enrolling in the Medi-Share 65+ health sharing plan.
Medigap Plan G, the most comprehensive Medigap plan still available to new enrollees, covers all Medicare Part A and B deductibles, coinsurance, and copays, except for the Medicare Part B annual deductible.
It also comes in a lower cost high-deductible version, which features a much lower monthly premium, though you would potentially have to pay out-of-pocket costs of up to $2800 in combined Medicare Part A and Part B expenses approved but not paid by Medicare before your plan benefits kick in.
LEARN MORE: Medigap Plan G, or to get a free quote.
Or for personalized assistance, contact a MediGap Advisors Personal Benefits Manager.
Medicare Advantage and Nursing Facility Benefits
Medicare Advantage plans offer the same coverage for skilled nursing facility care as Original Medicare (up to 100 days per benefit period if you meet certain conditions).
However, many Medicare Advantage plans also offer additional benefits that can help reduce your out-of-pocket costs.
Medicare Advantage plans tend to be very affordable monthly: many are available with a zero premium. However, you should be cognizant of potential high maximum out-of-pocket costs in the event you do need care.
Qualifying Requirements for Medicare Part A Coverage
To qualify for benefits, you must receive professional therapeutic services from skilled professionals at least five days per week.
Only professionals should provide skilled care. This includes nursing and therapies. That means physical therapy, occupational therapy, speech/language therapy services, respiratory therapy, wound care, IV administration, and the like.
Your doctor must verify that the care is medically necessary to improve your condition or to prevent it from getting worse.
Medications and Medical Supplies
Medicare also pays for medicines and necessary supplies while you’re in a skilled nursing facility. This covers items like dressings, catheters, and wheelchairs.
Your Rights in a Skilled Nursing Facility
At an SNF, you should know when you’re leaving.
The BFCC-QIO will send a “Notice of Medicare Non-Coverage” two days prior to service end. If you want the services to continue, you must appeal the decision by noon the day before the end date.
If the fast appeal deadline has passed, you can still ask for a quick review. The BFCC-QIO will then decide within two days after you submit your case. If they agree services must continue, Medicare will keep covering your needs. If not, you won’t have to pay for care before the original end date.
You have the right to fair treatment and the services you need while at the SNF. The BFCC-QIO will explain in detail why your services are ending and how Medicare rules apply.
Medicare’s Nursing Home Compare Tool
Medicare’s Nursing Home Compare tool on Medicare.gov is a key resource.
It lets you look for and compare SNFs by checking their performance in different areas. These include how well they are staffed, their health inspection scores, and the care they provide to residents. With this data, you can confidently choose a place that is right for you.
Local Directories and Referral Services
Besides the Medicare tool, you might want to contact local agencies, senior centers, or referral services.
They can give you lists of SNFs and rehab centers nearby. Hearing from others and getting recommendations helps find a place you trust for quality care.
With the help of Medicare and local sources, you can locate a facility that fits your needs. Being informed leads to better choices for your health and comfort. By gathering the right details, you pave the way for quality living and care.
Alternatives to Skilled Nursing and Rehab Facilities
If you don’t need the 24/7 care of a skilled nursing facility, there are other options.
These choices might be better if your condition is less severe. Or, if you can get better at home with some help.
Here are some of the top alternatives to skilled nursing and/or rehab facilities:
Home Health Care Services
With home health care, you can get skilled nursing and therapy at home.
It’s more wallet-friendly than inpatient care. The average cost of homemaker assistance is $30 per hour nationwide, according to the Genworth Cost of Care Study. While the average cost of a home health aide is $33 per hour.
Outpatient Rehabilitation
Outpatient rehab means you get therapy outside a nursing home.
It’s a good choice for those not needing intense inpatient care. Plus, it offers more freedom.
Outpatient rehab is generally covered under Medicare Part B. As of 2024, you have a $240 deductible for Part B. You must also pay 20% of the cost after you’ve covered the deductible, unless you have other coverage in place, such as Medicare Advantage or Medigap.
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Conclusion
If you need skilled care for a short time after leaving the hospital, Medicare can help. It takes care of the costs for this kind of care. Knowing the details can help you make smart choices about your health.
It’s important to look at all Medicare’s options, not just inpatient care. This way, you can choose what’s best for your health needs. It may save you money too.
Need help with your Medicare strategy? MediGap Advisors Personal Benefits Managers are experts in all things Medicare. We can help you choose the best plans available in your area, given your budget, medical situation, and lifestyle.
Appointments are free, and there’s never any obligation. Make an appointment today by clicking here!
For Further Reading: Medigap High Deductible Plan G: A Detailed Review|How To Find a Great Medicare or Senior Market Insurance Agent|Things Medicare DOESN’T Cover––And How To Protect Yourself
Leslie Alford is a Personal Benefits Manager at MediGap Advisors. Leslie has a passion for bringing clarity to those confused about Medicare. She is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Leslie on her Bio page.