Skilled nursing facilities are medical facilities that provide 24-hour medical care for their patients.
A person may go to a skilled nursing facility if he/she is ready to leave a hospital but still needs a certain type of medical care. A person may stay there for a day, weeks, or even months.
However, staying in a skilled nursing facility can be expensive, and not everyone who needs it can afford it.
So a common question many people have is, “Does Medicare cover Skilled Nursing?” In this article, we answer that question in clear, plain English. You will also find the average costs of skilled nursing facilities and other helpful info.
Does Medicare Cover Skilled Nursing?
The short answer is yes; Medicare will cover the cost of skilled nursing facilities. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your skilled nursing facility stay. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for skilled nursing facilities.
Coverage for skilled nursing facilities falls under Medicare Part A. However, for Medicare Part A to provide coverage for skilled nursing facility stay, certain conditions must be met. Those conditions are:
- Before going to the skilled nursing facility, the patient must have been an inpatient in a hospital for at least three days in a row
- The patient must start their time at a skilled nursing facility within 30 days of leaving the hospital
- The skilled nursing facility must be Medicare-approved
- The treatment that the patient receives must be for the same condition they were in the hospital for. And the patient requires that care 7 days a week.
- If therapy services are necessary, the patient must need that treatment at least five days a week
Services that Medicare covers, at least partially, during a stay at a skilled nursing facility include:
- Ambulance transportation
- Medical social services
- Medical supplies and equipment that are used in the facility
- Prescription drugs
- Dietary counseling
- Swing bed services
- Semi-private room
- Occupational therapy
- Physical therapy
- Speech-language pathology services
- Skilled nursing care
Changes in Coverage
Medicare Part A’s coverage will change the longer you stay in a skilled nursing facility.
During the first 20 days, Medicare Part A will fully pay the cost of your stay in a skilled nursing facility.
From days 21 to 100, you will be charged with a co-payment of $176 a day.
Once you exceed 100 days, Medicare Part A will no longer pay for your skilled nursing facility stay except for some medically necessary therapies. This will not include room and board however.
Sixty consecutive days after you are released from a skilled nursing facility or another hospital visit, a new benefit period starts. So, at that point, Medicare Part A will provide coverage for another 100 day stay in a skilled nursing facility.
Medicare Advantage plans (Medicare Part C) also provide coverage for skilled nursing facility stay. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and how much the out-of-pocket costs will vary depending on the specifics of your plan.
How Much Does It Cost To Stay In A Skilled Nursing Facility?
A private room in a skilled nursing facility costs an average of $300 per day and $8,800 per month. A semi-private rooms cost closer to $250 on average per day and $7,750 per month.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover LASIK?