[Last updated October 3, 2024]
A skilled nursing facility is a place where a person can stay for a short period of time to recover from an injury or illness, and it can also be a long-term residential solution for an individual who needs round-the-clock personal or medical care. In some cases, Medicare will pay for a person to stay at a skilled nursing facility for a limited period of time. Here, we’ll explain more about skilled nursing facilities (SNFs) and the circumstances in which Medicare will pay for you to get skilled care at one.
What is skilled nursing care?
A skilled nursing facility is a place where a person can receive nursing services and personal care. People receiving care at a skilled nursing facility can be long-term residents or short-term patients.
You might also hear SNFs referred to as nursing homes. A nursing home is a skilled nursing facility. The difference between the terms is that “nursing home” is usually used in connection with long-term care for a person, usually an older adult, while “skilled nursing facility” is commonly used in connection with a short-term stay when the patient requires rehabilitation or nursing care for a short period of time after a hospital stay for an injury, an illness, or surgery.
Does Medicare pay for a stay in a skilled nursing facility?
Medicare does not pay for long-term care at a nursing home. However, if the person is staying at the skilled nursing facility to receive short-term rehabilitative care, Medicare may pay for a short period of time. Specific circumstances and sequences of events have to be met first.
Here are some of Medicare’s qualifying criteria to cover a short-term stay in a skilled nursing facility:
- You have Medicare Part A and have hospital insurance days remaining in your benefit period. According to Medicare.gov, “A benefit period begins the day you’re admitted as an inpatient in a hospital or SNF. The benefit period ends when you haven’t gotten any inpatient hospital care (or up to 100 days of skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. … There’s no limit to the number of benefit periods.”
- You have a three-day qualifying inpatient hospital stay.
- Your doctor has certified that you need skilled nursing care, such as wound care, intravenous medications, or physical therapy.
- You searched for and want to be admitted into a Medicare-certified community.
- Your condition is either related to your hospital stay or occurred while you were in the hospital.
Qualifying inpatient hospital stay
Medicare covers skilled nursing care after a qualifying inpatient hospital stay, which means that during your stay, doctors have determined a medical necessity for skilled nursing care after you are discharged. Staying in the hospital under observation only typically does not qualify. In addition, the hospital stay must consist of more than three inpatient days, as stated in the Two-Midnight Rule, for Medicare Part A to cover a subsequent stay in a skilled nursing facility.
There are constraints to skilled nursing facility coverage from Medicare. Medicare covers medical services, so if you need only nonmedical custodial care (assistance with activities of daily living, like bathing, eating, and using the bathroom), Medicare will not cover it. This is a type of care that unlicensed professionals can provide.
In addition, your skilled nursing facility admission has to occur within 30 days of your discharge from the hospital for a reason related to your inpatient hospital stay. For example, if you were admitted into the hospital for congestive heart failure but want to be admitted into skilled nursing care for an untreated back injury (that did not occur while at the hospital), Medicare will not cover it.
For how long does Medicare pay for skilled nursing care?
Medicare has certain guidelines related to the timing and length of stay when determining whether it will cover skilled nursing care.
- For days 1-20 at the skilled nursing facility, the patient incurs no costs associated with this care.
- For days 21-100, the patient pays $204 a day.
- After day 100, you are responsible for paying 100% of the daily costs.
What services within a skilled nursing facility might Medicare pay for?
The services Medicare pays for in a SNF including the following:
- A shared room (you would likely not be the only person staying in the room).
- Meals.
- Medical care provided by a licensed vocational nurse, licensed practical nurse, registered nurse, nurse practitioner, or physician.
- Therapies pertinent to your care (if you are admitted for a leg injury, speech therapy, for example, would not be covered).
- Relevant social services.
- Prescriptions and medications.
- Supplies and durable medical equipment.
- Emergency transportation (if other modes of transportation would hinder one’s health).
What to do if you need skilled nursing care
If you or a loved one is currently in the hospital, don’t wait to start your search for a skilled nursing facility. You may only have one or two days’ notice of the hospital’s plan to discharge the patient, and it’s important to find the right facility that meets your or your loved one’s needs.
If you’re in the hospital
If you want to know if Medicare will cover your skilled nursing care, keep in close contact with discharge planners, such as your case manager or social worker, from the moment you’re admitted to the hospital and one is assigned to you. The hospital case managers and social workers likely have lists of facilities in the area. You also can do your own research on facilities near you to ensure that the one you choose offers the services you need and has good reviews.
When contacting potential skilled nursing facilities for your stay, confirm they are certified to provide Medicare-covered care. They’ll be able to provide you with clear financial details on paper.
If you’re at home or in a senior living community
Contact your doctor to confirm your medical need for this type of care. When evaluating skilled nursing care providers, contact the admissions director at the facility to confirm that it is a Medicare-certified provider. You can also look at ProPublica, which has published over 90,000 inspection reports detailing facility fines, violations, and more. A Certified Senior Advisor (CSA) or geriatric care manager may be able to recommend facilities to you.
Medicare and skilled nursing facilities
Knowing that Medicare does cover some of the services offered at a skilled nursing facility for a short time can bring peace of mind. Communicate with your doctor to determine whether the type of care they are recommending is something Medicare will cover. Keep in mind that there are several other ways to pay for skilled nursing care, including long-term care insurance, the Aid and Attendance benefit for Veterans, and more.
