Editor's Blog

Skilled Nursing Facilities and the Costs Medicare Won't Cover

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One of the benefits Medicare provides is coverage for a Skilled Nursing Facility. Many people are under the false impression that Medicare covers all of the costs associated with a Skilled Nursing Facility up to a stay of 100 days; however, this is not true. In fact, Medicare only covers all of the costs from Day 1 to Day 20. From the 21st day of your stay to the 100th day, you must pay $164.50 in coinsurance each day. If you were to stay in a SNF for 100 days, you would pay a total of $13,160 out-of-pocket in coinsurance. From Day 101 on, you must cover all costs accumulated at the SNF without any help from Medicare.

Your Skilled Nursing Costs with Original Medicare:

  • Day 1-20: $0
  • Days 21-100: $164.50 coinsurance per day
  • Days 101+: all costs

Skilled Nursing Facilities

To help better understand these costs, let’s first look at what defines a Skilled Nursing Facility. A Skilled Nursing Facility is much like a nursing home; however, they provide much more skilled medical expertise and services. They provide nursing care as well as rehabilitative services for those who are injured, sick, or disabled to help in getting patients back on their feet. Here is a list of services offered by Skilled Nursing Facilities from www.skillednursingfacilities.org:

  • Stroke Recovery – rehabilitation therapy, helping patients regain motor skills and speech functions.
  • Parkinson’s Care – specific care required to attend advanced Parkinson’s cases (does not apply to all facilities)
  • Custodial Care – helps patients with needs like bathing, dressing, and eating.
  • General Wound Care – cleans wounds and administers antibiotics for infection.
  • Acute Medical Conditions – services offered to help cases where an illness, infection, or injury threatens the patient’s health.
  • Terminal Illness Care – services offered along with hospice care for people living with terminal illness and require custodial care and medical care.
  • General Rehabilitation – speech, physical, and occupational therapy and other services to help patients recover after an extended illness or invasive operation.

Medicare Qualifications

Please note that Medicare only pays for skilled nursing when the patient has a qualifying inpatient hospital stay of 3 days, the doctor decides you need daily skilled care, and the SNF chosen is certified by Medicare. If all of these conditions are not met, Medicare will not cover any costs accumulated at the SNF.

Medicare Supplement (Medigap) Coverage of Skilled Nursing Facilities

To keep you from having to pay the high coinsurance payments out-of-pocket, certain Medicare Supplement, or Medigap, policies cover the coinsurance or copayments that come along with Skilled Nursing Facilities.

  • Medigap Plans C, D, F, G, M, and N all cover 100% of the coinsurance or copayments accumulated while in a Skilled Nursing Facility.
  • Medigap Plan K covers 50% of SNF copayments, and Plan L covers 75% of SNF copayments.

When a patient needs 24/7 intensive care, a Skilled Nursing Facility provides the expertise and services needed to ensure the patient receives the care they require. Although Medicare covers some of the costs brought along by Skilled Nursing Facilities, the high copayments can add up quickly, leaving the patient to pay them out-of-pocket in a time of need. The security of a Medigap plan during a stay at a Skilled Nursing Facility allows the patient to receive the care they need free of cost and free of worry.

Visit ManhattanLife's Medicare Supplement for plan information.


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