Does Medicare Cover Skilled Nursing Facilities?

When you’re on the edge of a big life change, like potentially entering a skilled nursing facility, or placing a family member in one, wondering how to pay can be of paramount concern. One common way of paying is with Medicare. 

Medicare is a federal government program, often administered by individual states, to provide health insurance to people over 65. In some cases, it will pay for skilled nursing facilities. However, there are a number of rules around when and how it can pay when it comes to skilled nursing facilities. 

While it’s always best to check with Medicare yourself to see if Medicare may apply to your unique situation, there are some general pieces of knowledge that can be helpful to understand. 

Read on for more information regarding Medicare and skilled nursing facilities.  

Basic Medicare Coverage for Skilled Nursing

Basic Medicare covers skilled nursing facility stays under certain conditions. 

There are generally two types of stay in a skilled nursing facility: short-term and long-term. Short-term stays are generally for people needing a transition between hospital and home. 

Long-term stays, or custodial care, are generally not covered under Medicare. Short-term stays are covered under certain conditions. 

All of the conditions for Medicare to pay for a skilled nursing facility stay can be found at medicare.gov, but the most important to note is that patients must have had a qualifying inpatient hospital stay. 

Patients also must generally enter the skilled nursing facility within 30 days of the hospital stay. In addition, your doctor or other healthcare provider must deem the stay medically necessary.  

One important thing to note is Medicare does generally pay for therapies offered in skilled nursing facilities, such as speech therapy, or occupational therapy. As always, certain conditions must be met. 

Call Monument Health Group For More Information On Our Top-Quality Skilled Nursing Care.

Understanding The Benefit Period

One other thing you’ll have to calculate is your Medicare benefit period. 

The benefit period is a way that Medicare measures the use of services, in this case hospital stays and skilled nursing facility stays. It determines how long you can receive coverage and how often you may need to pay a deductible. 

The benefit period begins the day you are admitted to a hospital or a skilled nursing facility. It ends when you’ve gone 60 days in a row without inpatient care. If you go back to the hospital or skilled nursing facility, a new benefit period begins and you may need to pay the deductible again. 

For those with traditional Medicare, Medicare generally covers the costs for skilled nursing facilities for up to 20 days completely, as long as a patient has days left in their benefit period. Beyond that, patients generally must pay a co-pay, and beyond 100 days, patients must pay the full measure.

If you’re on a Medicare Advantage plan, these rules may differ. 

The Role Of Medicare Advantage Plans

Medicare Advantage plans are Medicare plans offered by private insurers and approved by the Medicare organization. They may have different cost structures than traditional Medicare. 

If you have a Medicare Advantage plan, it’s best to contact your insurer to inquire about the rules for your specific plan as it relates to skilled nursing facilities in Utah, or anywhere else, as rules can differ from traditional Medicare.

There may be restrictions on which facilities you can choose or other restrictions. This information may be found in your plan documentation, or can be provided by the insurer. 

What Medicare Doesn’t Cover 

The most important thing to understand about what Medicare does not cover, is that it generally only covers short-term stays. In general, it does not cover long-term care for those with chronic illnesses. 

Even for those in need of short-term care, Medicare does not cover stays of more than 100 days, it does not cover completely private rooms, and it does not cover other costs that can be associated with skilled nursing stays and can be considered extra, such as telephone charges. 

Finally, Medicare will only cover cases that have been deemed medically necessary at the level of care of a skilled nursing facility. 

Skilled Nursing Facility Coverage In Utah

If you or a loved one needs skilled nursing care in Utah, give us a call today. We pride ourselves on outcomes, respect, compassion, and knowledge. When you come to a Monument Health Group’s facility, you are always in good hands, and we treat everyone who walks through our doors like family. 

Call Monument Health Group Today.

Sources:

Nursing Homes. (2025). 

Skilled Nursing Facilities. (2025). 

Skilled Nursing Facility Care. (2025).