Skilled nursing facilities are places where you can stay to get professional medical care after leaving a hospital. Your health care provider may recommend a skilled nursing facility to you if you need further treatment or rehabilitation.
But does Medicare pay for a skilled nursing facility stay? If you have Medicare, skilled nursing facility stays may be partially covered. But coverage can be limited. Understanding the situations where you’re covered is key.
Does Medicare Part A provide coverage in a skilled nursing facility?
Medicare Part A offers hospital insurance. And it may also provide coverage in a skilled nursing facility.
Medicare Part A covers skilled nursing care for a short time in a skilled nursing facility. To get these benefits, you must meet Medicare’s rules, like having a recent hospital stay for at least three days in a row. This coverage only lasts for a limited number of days.
Do Medicare Advantage plans cover skilled nursing facilities?
Medicare Advantage (Part C) offers all the coverage you get from Original Medicare (Parts A and B), but often with added benefits. Similar to Part A, you may be able to get Medicare coverage in a skilled nursing facility with Part C. But the details of your coverage vary depending on your specific plan. Be sure to refer to your Evidence of Coverage (EOC) for plan details.
Learn more about Medicare Advantage plans
Do Medicare Special Needs Plans (SNPs) cover skilled nursing facilities?
Medicare Special Needs Plans (SNPs) offer coverage to people with specific health conditions or needs. The SNPs include the following plans:
- Dual Eligible Special Needs Plans (D-SNPs) are for people who are eligible for both Medicare and Medicaid.
- Chronic Condition Special Needs Plans (C-SNPs) are for people who have certain severe or disabling chronic conditions.
- Institutional Special Needs Plans (I-SNPs) are for people who need to live in a long-term care center, like a nursing home. I-SNPs give you a personal care team to help with your overall health. They’ll work with your primary care provider (PCP) and long-term care facility to provide smooth, coordinated care.
An Institutional Special Needs Plan (I-SNP) is often a good option for skilled nursing facility coverage, since these plans offer added benefits for people living in long-term care facilities. Coverage for skilled nursing facilities varies depending on your plan.
Medicare requirements for skilled nursing coverage
Medicare coverage for skilled nursing facilities comes with some requirements. You may be covered by Part A if:
- You have Medicare Part A with days left in your benefit period
- You first have a qualifying inpatient hospital stay of at least three days in a row
- You begin your stay at the skilled nursing facility within 30 days of leaving the hospital
- Your health care provider has decided you need daily skilled medical care
- You are getting care at a Medicare-certified skilled nursing facility
You can also get skilled nursing coverage outside of a facility. Skilled nursing care is daily professional medical care you get from a nurse or similar health care provider. You may also be able to get skilled nursing care at home or in an assisted living place.
How many days will Medicare pay for a skilled nursing facility?
During a single benefit period, Medicare Part A will help pay for skilled nursing facility stays for up to 100 days. Your benefit period is the time during which you get covered care. It ends and resets when you have not gotten skilled nursing facility care for 60 days in a row. This is how your costs work during your benefit period:
- From day 1-20 of your stay, you pay $0 after your deductible is paid.
- From day 21-100, you pay $217 for each day.
- From day 101 onward, you pay the full cost of each day.
Need help paying? Find out if you qualify for financial assistance programs
You can also get skilled nursing coverage with an Aetna Medicare Advantage plan or Special Needs Plan. Costs may vary depending on your specific plan. Learn more about your Medicare Advantage plan or Special Needs Plan coverage and compare with other plans.
What’s the difference between a skilled nursing facility and assisted living?
Assisted living and skilled nursing facilities are often mistaken for one another. Some of the services they offer are similar, but they have a few key differences. For example, if you have longer term care needs, you might choose assisted living over a skilled nursing facility. Here’s a breakdown of their differences.
Skilled nursing vs assisted living facility comparison chart
| What they cover | Skilled nursing facility | Assisted living |
|---|---|---|
| Medical care | Yes, skilled nursing facilities offer professional medical care. They often help with recovery or rehabilitation after hospital stays. | Yes, you can get professional medical care while in assisted living. Many assisted living places have their own medical staff. |
| Custodial care | No | Yes, assisted living places offer services like help with eating, bathing, medication and other daily tasks. |
| Length of care | Generally short term. The purpose of a stay at a skilled nursing facility is to recover before returning home. | Generally long term. Most people move into assisted living places for ongoing help with daily life. These stays last until their needs change, either because they can live independently again or because they need different care. |
Assisted living offers long-term help with daily tasks like meals and bathing. Skilled nursing facilities focus on short-term care and rehab after a hospital stay. Medicare coverage varies between skilled nursing facilities and assisted living.
Unlike skilled nursing facilities, Medicare doesn’t usually cover assisted living costs like custodial care or room and board. But skilled nursing care may be covered in an assisted living facility if it’s medically necessary. For example, if you’re staying in an assisted living place and need injections or physical therapy, that care may be covered.
Can't leave home? You can get a lot of the same care offered by assisted living and skilled nursing facilities at home with home health care.
What’s the difference between a skilled nursing facility and a nursing home?
You can usually get skilled nursing care at both nursing homes and skilled nursing facilities. But nursing homes offer custodial care (help with daily activities like bathing and dressing) while skilled nursing facilities don’t. Medicare also treats them differently. Stays in nursing homes are not usually covered by Medicare. But skilled nursing care you get in a nursing home may be covered if it’s medically necessary.
Disclaimer
The Aetna C-SNP is available to Medicare members who have at least one of the qualifying chronic conditions. To ensure a successful enrollment process, we’ll confirm with your healthcare provider that you have one of these eligible conditions. If verification of eligible condition is not received, involuntary disenrollment will occur.