Aug 2, 2023

How to pay for a skilled nursing facility

Manny Cominsky

As seniors and their families navigate the challenges of finding appropriate care, understanding how to pay for a skilled nursing facility becomes a crucial aspect of the decision-making process. Skilled nursing facilities, also known as nursing homes or convalescent homes, provide comprehensive care for individuals with chronic health conditions or those recovering from surgery or illness. However, the cost of skilled nursing care can be significant, and it's important to explore various payment options and resources available. This comprehensive guide aims to shed light on the cost of skilled nursing care and provide insights into different payment methods and financial assistance programs.

The Cost of Skilled Nursing Care: Exploring the Expenses

Before delving into the payment options, it's essential to grasp the overall cost of skilled nursing care. The expenses associated with skilled nursing facilities can vary significantly depending on factors such as location, the level of care required, facility size, and amenities offered. On average, the cost of a shared room in a skilled nursing facility is around $7,908 per month or approximately $260 per day. However, it's crucial to note that these figures are subject to change and can vary based on geographical region and facility ratings.

It's important to recognize that skilled nursing facilities offer a higher level of care compared to other senior care options such as assisted living or memory care communities. Skilled nursing facilities provide specialized resources administered by licensed professionals, including wound care, feeding assistance, injections, physical therapy, and assistance with activities of daily living (ADLs). These comprehensive services contribute to the higher costs associated with skilled nursing care.

Payment Options for Skilled Nursing Care: Exploring the Alternatives

Medicare Coverage for Skilled Nursing Facilities

Medicare, a federal program providing health coverage for individuals aged 65 and older, offers limited coverage for skilled nursing facility stays. It primarily covers short-term stays for individuals requiring intensive rehabilitation or recovery after a hospitalization. Medicare will fully cover the first 20 days of skilled nursing care and partially cover days 21 to 100, with the requirement of a daily co-payment. However, it's important to note that Medicare does not cover long-term care in skilled nursing facilities beyond the initial 100 days.

Medicaid: Financial Assistance for Skilled Nursing Care

Medicaid, a joint federal and state program, plays a significant role in covering nursing home costs for individuals with limited income and resources. While Medicaid coverage varies from state to state, it is the largest single payer for nursing home care in the United States. Medicaid eligibility is often based on income and personal resources, and individuals must meet strict financial guidelines to qualify. If eligible, Medicaid can cover 100% of nursing home costs at Medicaid-approved skilled nursing facilities. It's important to research and understand the specific Medicaid eligibility requirements in your state and whether the nursing home of choice accepts Medicaid payment.

Long-Term Care Insurance: Planning Ahead for Skilled Nursing Care

Long-term care insurance can provide financial assistance for various types of long-term care, including skilled nursing facility stays. These insurance policies can vary widely, with some covering only nursing home care and others encompassing a broader range of services like assisted living, adult day care, and home care. It's crucial to review the policy details and coverage before making a decision.

Long-term care insurance policies often have specific triggering events or medical criteria that determine when the policyholder can start receiving insurance payouts for their care needs. Premium rates for long-term care insurance are influenced by factors such as age, health status, and coverage options. It's advisable to purchase long-term care insurance well in advance, as premiums tend to be lower for individuals in good health when they apply.

Personal Resources: Self-Payment for Skilled Nursing Care

For individuals who have personal savings, pensions, stocks, or other assets, self-payment can be an option to cover skilled nursing care. Using personal funds and savings can provide more flexibility and control over the choice of skilled nursing facility. Additionally, some insurance companies allow policyholders to use their life insurance policies to pay for long-term care.

It's important to consult with insurance providers to understand the coverage and options available for utilizing personal resources to pay for skilled nursing care. Exploring these self-payment options can provide individuals and their families with greater financial independence when making decisions about long-term care.

Veterans Assistance for Skilled Nursing Care

For veterans and their spouses, the U.S. Department of Veterans Affairs (VA) offers benefits that may cover the costs of skilled nursing care. Eligibility for VA benefits is determined by factors such as individual health care needs, income, disability level, and location. VA benefits may include coverage for nursing home costs, and eligible veterans may qualify to live in VA nursing homes. It's essential to be enrolled in VA health care and meet the necessary requirements to access these benefits.

Other Options: Reverse Mortgages and Personal Assistance

In certain situations, individuals may consider alternative options to help finance skilled nursing care. Reverse mortgages, for example, allow homeowners to convert their home equity into cash, which can be used to offset the costs of nursing home care. However, it's important to carefully consider the terms and fees associated with reverse mortgages and consult with financial institutions for reliable guidance.

Additionally, personal assistance from family members or bridge loans, which offer short-term financing, can be considered as temporary solutions while exploring other payment options or waiting for the sale of assets.

Navigating the Complexities: Seeking Professional Guidance

Understanding how to pay for a skilled nursing facility and navigating the complexities of financing long-term care can be overwhelming. It's highly recommended to seek professional guidance from geriatric care managers, financial advisors, elder law attorneys, and insurance experts who specialize in senior care planning. These professionals can provide invaluable advice tailored to individual circumstances, helping seniors and their families make informed decisions regarding payment options and financial planning for skilled nursing care.

Paying for skilled nursing care requires careful consideration of various payment options and financial assistance programs. It's crucial to understand the costs associated with skilled nursing facilities and explore options such as Medicare, Medicaid, long-term care insurance, personal resources, veterans assistance, and alternative financing solutions. Seeking professional guidance can provide seniors and their families with the necessary support and expertise to navigate the complexities of financing skilled nursing care. By understanding the available options and planning ahead, individuals can make informed decisions and ensure the highest quality of care for their loved ones in a skilled nursing facility.

To learn more about how Sunbound can help make senior care more affordable for you or your loved one, send us an email at or request more information on Sunbound. Sunbound is the best way to pay for senior living and senior care and is on a mission to make senior living affordable for everyone.

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