Medical Bills6 min read

Skilled Nursing Facility Bill Explained

A skilled nursing facility bill covers the cost of rehabilitative or medical care provided in a nursing facility after a hospital stay. Medicare covers the first portion of a qualifying stay, but copays kick in after day 20, and coverage ends entirely after day 100. This guide explains the billing structure and what to watch for.

This guide is general educational information, not professional advice. If the document involves a serious deadline, lawsuit, tax issue, health decision, or major financial consequence, get qualified help.

What this document usually means

A skilled nursing facility bill covers room and board, skilled nursing care, physical therapy, occupational therapy, speech therapy, medications, and medical supplies during your stay. Under Medicare Part A, the first 20 days of a qualifying stay are covered with no copay. Days 21 through 100 require a daily coinsurance amount (which changes annually). After day 100, Medicare coverage ends.

To qualify for Medicare SNF coverage, you must have had a qualifying hospital stay of at least three consecutive inpatient days and need skilled care for a condition related to the hospital stay.

The first things to check

Verify the admission and discharge dates. Confirm that your hospital stay met the three-day inpatient requirement, as observation stays do not count. Check which days fall into each Medicare coverage period: days 1 through 20 (no copay), days 21 through 100 (daily copay), and beyond day 100 (no Medicare coverage).

If you have a Medigap policy, check whether it covers the daily copay for days 21 through 100. Some Medigap plans cover this coinsurance in full.

Common reasons this letter feels confusing

The most common confusion is around the three-day qualifying hospital stay requirement. If any of those days were classified as observation rather than inpatient, the SNF stay may not be covered by Medicare at all, resulting in a full bill to the patient.

The daily copay that begins on day 21 can also catch people off guard, as the amount is substantial and changes each year. For 2024, the daily coinsurance was over $200 per day.

What to do before you pay or respond

Request an itemized statement and compare it to your Medicare Summary Notice. If Medicare denied coverage, check whether the denial was due to the three-day stay requirement, a medical necessity determination, or an administrative issue. You have the right to appeal Medicare SNF denials.

If you are approaching day 100 or if Medicare coverage was denied, ask about Medicaid eligibility, which can cover nursing facility costs for people with limited income and assets. The facility should have a social worker who can help with Medicaid applications.

How Letter Lens can help

Upload your SNF bill to Letter Lens for a clear explanation of the charges, the Medicare coverage periods, and your copay responsibility. Letter Lens identifies which days are covered, calculates the daily copay amounts, and highlights any charges that seem incorrect.

Key Terms Decoded

Skilled nursing facilityA facility providing skilled nursing care and rehabilitation services, often following a hospital stay.

Three-day qualifying stayThe requirement that you spend at least three consecutive days as a hospital inpatient to qualify for Medicare SNF coverage.

Observation statusA hospital classification that does not count toward the three-day inpatient requirement for SNF coverage.

Daily coinsuranceThe amount you pay per day for SNF care during days 21 through 100 of a Medicare-covered stay.

Benefit periodThe period that begins when you are admitted and ends 60 days after you stop receiving skilled care.

MedigapA supplemental insurance policy that helps cover costs Medicare does not pay, including SNF coinsurance.

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