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Special Considerations: Paying For A Skilled Nursing Facility

Patients needing post-hospital care in a skilled nursing facility who are enrolled in Medicare are covered for stays of up to 100 days in a Medicare-certified skilled nursing facility if the patient meets Medicare's requirements. 

The nursing facility and Medicare use specific assessments to determine whether Medicare will pay for the patient's stay, or the patient will be responsible for some or all of the cost.

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After the 100 days patients are responsible for all costs—some or all of which can be covered private insurance or Medicaid for those who are eligible.

For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period is $176 in 2020

Skilled nursing facilities cannot charge a buy-in fee, as some assisted living communities do, and are required to put their services and fees in writing and give these details in advance to the patient or the patient's caregiver.

Skilled nursing facilities can be extremely expensive for long-term stays. In 2019, for example, a private room in a skilled nursing facility or nursing home cost an average of $102,200 a year, according to a report on long-term care by Genworth.

Medicare Advantage plans are private health insurance plans that offer some dental benefits and may cover routine preventive care, such as cleanings, X-rays, and regular exams, either partially or in full, and also provide some coverage for extractions, root canals, dentures, crowns, fillings, and treatment for gum disease.