Financial Options
Paying for a Skilled Nursing Facility (SNF) stay can be complex, and the options depend on factors like the length of stay, the reason for the stay (short-term rehab vs. long-term care), income, assets, and insurance coverage.
Here are the main financial options available:
1. Medicare
Eligibility:
- You must have Medicare Part A.
- A qualifying hospital stay of at least 3 consecutive days (not including the discharge day).
- Admission to the SNF within 30 days of hospital discharge.
- Doctor-certified need for skilled care (like rehab, wound care, or IV therapy).
Coverage:
- Days 1–20: Fully covered by Medicare.
- Days 21–100: You pay a daily coinsurance (e.g., $204/day in 2024, but varies).
- After day 100: Medicare does not pay — you pay 100% of the costs.
Note: Medicare covers short-term rehabilitation, not long-term custodial care.
2. Medi-cal
Eligibility:
- Based on income and asset limits set by California
- Usually covers long-term SNF stays once a person spends down their assets to qualify.
Coverage:
- Covers room, board, and nursing care for long-term stays.
- A person may need to “spend down” assets to qualify. Some assets (like a primary home or car) may be exempt.
3. Private Pay (Out-of-Pocket)
- You pay full cost directly.
- Often used until a person qualifies for Medicaid.
4. Medicare Advantage Plans –
- May need pre authorization for care
- May not require three day hospital stay prior to admissions
- Approval and authorization varies based on insurance carrier.
5. Long-Term Care Insurance
- Pays for skilled nursing care depending on the policy.
- Coverage, waiting periods, and daily benefit limits vary.
- Must have purchased before needing care — not a viable option if care is needed immediately.
- Facility must verify prior to admission.