Understanding the distinction between a skilled nursing facility (SNF) and a nursing home is crucial for individuals and families who are navigating their long-term care options. While both SNFs and nursing homes provide care for people who require assistance with daily activities and medical needs, there are important differences in the level of care provided and the intended duration of stay.
Skilled nursing facilities are designed to offer short-term, intensive rehabilitative care following a hospital stay for conditions such as a stroke, surgery, or injury. On the other hand, nursing homes, also known as long-term care facilities and assisted living facilities, cater to individuals who require ongoing assistance with activities of daily living such as bathing, dressing, and using the restroom, and who may also need assistance with their medical needs. In this article, we’ll walk through the details of how these two facilities differ, when you might stay in one versus the other, and whether they’re covered under Original Medicare.
What are skilled nursing facilities (SNFs) and nursing homes?
SNFs are specialized healthcare centers that provide short-term, intensive medical and rehabilitative care to individuals recovering from acute medical conditions or surgeries. These facilities offer 24-hour skilled nursing care and services like physical therapy, occupational therapy, and speech therapy. Patients typically transition to a skilled nursing facility after a hospital stay when they require a higher level of medical care and rehabilitation before returning home. SNFs are designed to facilitate a patient's recovery and transition back to independent living, focusing on improving functional abilities and overall health.
Alternatively, nursing homes cater to individuals who require ongoing assistance with activities of daily living and medical care. Residents in nursing homes often have chronic or long-term conditions that necessitate custodial care and supervision. Nursing homes provide a supportive environment for individuals who are unable to live independently due to physical, emotional, or cognitive limitations. These facilities offer assistance with daily activities such as bathing, dressing, medication management, and mobility, while also providing access to skilled nursing care when needed.
Does Original Medicare cover stays in skilled nursing facilities and nursing homes?
Yes, Original Medicare does provide coverage for both skilled nursing facilities and nursing homes, but the coverage and eligibility criteria differ:
Skilled Nursing Facilities: Original Medicare Part A covers skilled nursing care in a certified skilled nursing facility under specific conditions. To be eligible for this coverage, the individual must have been formally admitted to the hospital for at least three days and then transferred to a certified SNF for further skilled care related to the hospital stay. Medicare covers up to 100 days of skilled nursing facility care per benefit period, with certain conditions and limitations.
Nursing Homes: While Original Medicare provides coverage for short-term skilled nursing care and rehabilitation in a skilled nursing facility, it does not cover ongoing long-term care in a nursing home for activities of daily living. However, Medicare Part A and Part B may cover certain medically necessary services provided by a nursing home, such as skilled nursing care, physical therapy, and other services, but only for a limited time and under specific circumstances.
Do Medicare Advantage plans cover stays?
Medicare Advantage plans must legally cover the same services as Original Medicare. This means that beneficiaries with a Medicare Advantage plan will have the same coverage as they would under Original Medicare.
Some Medicare Advantage plans may offer additional benefits beyond what Original Medicare covers, but the specifics of this coverage will depend on the individual plan. Every Medicare Advantage plan has its own network of providers, coverage rules, and out-of-pocket costs, so it's essential to carefully review your Medicare Advantage plan's documentation or speak with your carrier or representative to fully understand the coverage.
Plan for the Future With the Help of SelectQuote
Whether you’re a caretaker or a Medicare beneficiary, it’s a good idea to stay informed about short-term and long-term care facilities like skilled nursing facilities and nursing homes. While Original Medicare may cover stays in these types of facilities, understanding the intricacies of your coverage may feel overwhelming. Fortunately, with nearly 40 years of experience, our licensed insurance agents are prepared to help you understand your coverage and, if eligible, shop for a Medicare Advantage plan if you determine that’s right for you and your healthcare coverage needs.
