Today in the United States there are over 1.4 million people who are using skilled nursing facilities for long- or short-term care. Typically, Original Medicare Part A covers the cost of skilled nursing care when it is on a short-term basis and needed for post-acute or rehabilitative care. Medicare does not offer coverage for long term custodial care in a skilled nursing facility.
If you have Original Medicare insurance alone, it may fall short in covering all the costs involved in your skilled nursing facility care. Having a supplemental insurance plan, such as a Medigap “M” policy, may help you pay for some of those expenses. With a Medicare supplement plan you may not have to use up your savings or family assets to cover your expenses while in a SNF. Here are the details about how a Medigap “M” policy could help you.
Can Medigap Plan M Help Cover Skilled Nursing Care?
Medigap, Medicare Supplement, insurance policies that are sold by private insurance companies with the aim of filling in the coverage gaps in Original Medicare insurance. Before looking at how a Medigap M plan helps pay for nursing care, let’s look at how Medicare Part A covers it.
Through Medicare Part A (hospital insurance), recipients are covered for 100 percent of the cost of skilled nursing facility care for the first 20 days. From day 21 and up to day 100, you are required to pay (out of pocket), a daily copayment. After 100 days, you are responsible for all costs associated with your skilled nursing facility care.
As of January 1, 2020, the coinsurance costs for days 21-100 are $176.00 per day of each benefit period. As mentioned above, after day 100 you pay all SNF costs.
Through Medicare Part A, you are also responsible for paying a deductible for every benefit period that you use SNF care. As of January 1, 2020, the Part A deductible is $1,408.00. This is an increase of $44.00 from 2019.
If you have Medicare Supplement Plan M, this policy covers all your coinsurance costs for days 21 through 100 of your skilled nursing facility care for each benefit period involved. Medigap Plan M also pays for 50 percent of the Medicare Part A deductible for every benefit period involved.
What is a Benefit Period?
Medicare uses the benefit period as a way to measure your use of inpatient hospital and SNF services. The benefit period starts on the day you are admitted to either a hospital or nursing facility. The benefit period ends when 60 consecutive days have passed after your care has ended.
Benefit periods are also used to determine how much you pay for your stay. For every separate benefit period you have a stay, you must pay your Part A deductible at the beginning of that benefit period. You must also pay your coinsurance for days 21-100 for every benefit period involved. There is no limit to the number of benefit periods you can have, or no limit to how long a benefit period lasts.
For example, if you have knee replacement surgery on January 1st and enter a skilled nursing facility for post-acute care on the same day, your benefit period begins on January 1st. If you leave the facility on January 20th but return on January 25th, you are still in the same benefit period. If you do not return until 61 days after January 20th for further care, you begin a new benefit period at that time.
Medicare Part A offers coverage for skilled nursing facility care for up to 100 days in each benefit period involved. If you need more than 100 days of care per benefit period, you must pay out of pocket.
If you are someone who may need skilled nursing facility care on a regular basis, having a Medigap Plan M that pays your coinsurance of $176.00 (as of 2020) for days 21-100, as well as 50 percent of your Part A deductible for every benefit period involved, may be a wise investment.
Does Medicare Have a Deductible? (Opens in a new browser tab)
Does Medigap Cover Long-Term Care? (Opens in a new browser tab)