Medicare and Skilled Nursing Facilities
TL:DR (AKA Too Long, Didn’t Read. As the kids say!)
Medicare helps pay for skilled nursing facilities (SNF), but not necessarily the full amount.
If you’re choosing prior to, best to talk to a certified Medicare brokerage for your options in your area.
Why Skilled Nursing and Medicare Deserve a Closer Look
Today, we’re going to dive into Medicare and skilled nursing facilities (SNF). As I thought it would be appropriate to discuss this in longer form, as my grandma recently needed to go to a skilled nursing facility due to a broken femur.
How Medicare Coverage for Skilled Nursing Actually Works
How exactly does Medicare and skilled nursing facilities work you may be wondering? Well, that all depends on the type of Medicare you have.
Original Medicare (Part A, Part B)
Medicare Advantage
Medicare Supplement/Medigap
Skilled Nursing Coverage Under Original Medicare
Original Medicare is simple, it’s $0 for the first 1-20 days, followed by a daily coinsurance for days 21 - 100 (usually around $218 a day for 2025-2026), then day 101 and beyond is private pay.
The facility wanted my grandma to go this route (pretty sure it’s easier to bill). Slight problem though, Original Medicare has you on the hook for 20% coinsurance with no yearly cap.
How Medicare Advantage Changes Skilled Nursing Costs
Medicare Advantage, similar to Original Medicare, $0 for the first 1 - 20 days, followed by a daily coinsurance for days 21-100 (again usually around that $218 a day), then day 101 and beyond is private pay.
HOWEVER, once you hit your plans specific, yearly, out of pocket maximum (call your insurance company or agent and ask), you’re done paying for the year.
It works like this: you break your hip, have to go to skilled nursing, you’re there 70 days. First 20 are $0, day 21-70 is that approximate $218, for a grand total of $10,682.00. Which is a big bill for anyone, BUT your plan has a yearly out of pocket maximum of $4,500, thus once hitting the $4,500, you’re good to go for the remainder of the year!
Skilled Nursing Coverage With Medicare Supplement (Medigap) Plans
Lastly, Medicare Supplement/Medigap, also similar to the first 2, but depending on your Plan (G,N,F,K,etc..) $0 for the first 1-20 days, followed by a daily coinsurance for days 21-100 that the Supplement plan picks up (typically). This one is pretty straightforward.
The Key Takeaway When It Comes to Skilled Nursing Care
Moral of this little story, make sure you have or can get Medicare Advantage (sometimes referred to as MA or MAPD) or a Medicare Supplement plan. Those make your stays a lot smoother, lord knows insurance is the last thing on your mind during these times.
For more questions about your plan, reach out to us at any time!
