Do Medicare benefits Cover Skilled Nursing Care?
Choosing the right kind of post-hospital care under Medicare’s rules can be confusing. The nonprofit Medicare Rights Center recently offered a webinar explaining some of the basics on Medicare and skilled nursing facility care (SNF). The webinar addressed common questions about Medicare benefits, including who qualifies for Medicare-covered SNF care, what services Medicare covers, and how much Medicare recipients may need to pay out of pocket.
Understanding Medicare’s rules for SNF care is useful for older adults, people with disabilities, and family caregivers, particularly because confusion about SNF coverage can lead to unexpected bills.
What Is Skilled Nursing Facility Care?
Skilled nursing facility care is short-term, medically necessary care provided in a licensed facility following a hospital stay. SNFs offer a higher level of care than custodial nursing homes or assisted living communities. The care must be provided by, or under the supervision of, licensed medical professionals such as registered nurses (RNs) or physical therapists.
Common reasons someone might need SNF care include:
- Recovery after surgery
- Rehabilitation following a stroke or serious illness
- Wound care or IV therapy
- Physical, occupational, or speech therapy
- Monitoring and treatment of complex medical conditions
SNF care is designed to help individuals recover and regain function so they can safely return home or to a lower level of care.
When Does Medicare Cover Skilled Nursing Facility Care?
Medicare Part A (hospital insurance) covers skilled nursing facility care only if specific conditions are met. To qualify for Medicare-covered SNF care, the Medicare recipient generally must meet each of the following requirements:
- A qualifying inpatient hospital stay. The person must have been admitted to a hospital as an inpatient for at least three consecutive days, not counting the day of discharge. Time spent in the hospital under “observation status” does not count toward this requirement.
- Admission to the SNF shortly after hospital discharge. The SNF stay usually must begin within 30 days of leaving the hospital.
- A medical need for skilled care. The care must be medically necessary and require skilled services, such as daily nursing care or rehabilitation therapy that can only be provided by trained professionals.
- A Medicare-certified skilled nursing facility. The facility must be certified by Medicare.
If these criteria are met, Medicare Part A may help pay for SNF care on a limited, short-term basis.
What Services Does Medicare Cover in a SNF?
When Medicare covers SNF care, it generally includes:
- A semi-private room
- Meals
- Skilled nursing services
- Physical, occupational, and speech therapy
- Medical supplies and equipment used during care
- Qualifying medications related to the SNF stay
- Ambulance transportation to the nearest provider of necessary services if other modes of transportation would pose a health risk
When Does Medicare Not Cover Skilled Nursing Facility Care?
In some situations, Medicare will not cover skilled nursing facility care.
Medicare does not cover:
- Long-term or custodial care, such as help with bathing, dressing, or eating when no skilled medical care is required
- SNF stays that do not follow a qualifying three-day inpatient hospital admission
- Care in facilities that are not Medicare-certified
- Continued SNF care once the patient no longer needs skilled services
How Much Does SNF Care Cost Under Medicare?
Medicare-covered SNF care is limited to up to 100 days per benefit period, and costs depend on how long a person stays.
- Days 1 to 20: Medicare Part A pays the full approved cost.
- Days 21 to 100: Part A covers part of the cost. The patient pays a coinsurance, which will be $217 per day in 2026.
- After day 100: The patient pays all the costs of their SNF care.
Medigap (Medicare Supplement) plans may cover some or all the daily coinsurance for days 21 to 100, depending on the plan.
Why Understanding Skilled Nursing Facility Care Coverage Matters
Confusion about SNF coverage can lead to financial strain and difficult decisions during an already stressful time. Many people assume Medicare will cover a stay in a skilled nursing facility indefinitely, when in reality, coverage is limited and tied strictly to skilled medical needs.
Before a hospital discharge, patients and caregivers should ask:
- Was the hospital stay at least three consecutive days and classified as inpatient rather than observation?
- Does the recommended skilled nursing facility provide Medicare-certified SNF care?
- What services will be considered “skilled,” and for how long?
- What happens when Medicare coverage ends?
Getting Help Navigating SNF Care
Engaging with a skilled elder law attorney who is well-versed as a long-term care planner is vital. Contact McDonald Law Firm, an experienced Howard County, Montgomery County and District of Columbia estate planning, special-needs planning and Medicaid planning law firm, at (443) 741-1088; (301) 941-7809, (410) 337-8900 or (202) 640-2133 or use the following link: https://www.mcdonaldesq.com/#contactWrapper to schedule a no obligation consultation to speak with one of our experienced attorneys.
DISCLAIMER: THE INFORMATION POSTED ON THIS BLOG IS INTENDED FOR EDUCATIONAL PURPOSES ONLY AND IS NOT INTENDED TO CONVEY LEGAL, INSURANCE OR TAX ADVICE.
