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How can I evaluate a skilled nursing facility’s copayments?

I am evaluating Medicare Advantage plans for my mother-in-law. Her care needs are increasing and we suspect she may need to go to a nursing home some time in the next few months. Here are the copayments for skilled nursing care for two plans.

Plan A: Days 1-20—$0 copayment per day; days 21-100: $130 copay per day.

Plan B: Days 1-20—$50 copay per day; days 21-46—$150 copayment per day; days 47-100: $0 copay per day.

When I add up the numbers, Plan A would cost us $10,400 for 100 days and Plan B would be $4,750.  Sounds to me like Plan B is the better option.

Looking just at the rates, Plan B is definitely the better option. However, it’s unlikely your mother-in-law or anyone else will qualify for the full 100 days of coverage in a skilled nursing facility (SNF). The average length of a Medicare stay in 2010 was 27 days. That average length stay would cost $910 under Plan A and $2,050 under Plan B. Many stays covered by Medicare are considerably shorter.

That’s because Medicare covers skilled care in an SNF—that’s care provided by nursing or rehabilitation staff to treat, manage, observe, and evaluate your care. Examples of skilled care include intravenous injections and physical or occupational therapy. Medicare does not cover custodial or personal care. 

FYI:  Here are the applicable rates for those on Original Medicare.

Days 1-20—$0 copayment per day.

Days 21-100—$161 copayment per day.

A Medigap policy (Medicare supplement plan) may or may not cover the copayments.  


Last updated: 12-30-2015