After a fall, surgery, stroke or sudden illness, you may need more care than you can get at home yet not enough to stay in the hospital. That is when a skilled nursing facility becomes a necessary part of your recovery process. Below, this Medicare Supplement agency in Michigan City, Indiana is going to explain how Medigap works with skilled nursing facility care.

What does Medicare pay for in a skilled nursing facility?

Medicare Part A does cover skilled nursing care but only if some specific conditions are met.

The first requirement is an inpatient hospital stay of at least three full days. This rule is very strict, and time spent under “observation status” does not count. If the hospital marks you as “observation” instead of “inpatient,” Medicare can deny the skilled nursing facility stay entirely.

The second requirement involves timing. You must enter a Medicare-approved skilled nursing facility soon after leaving the hospital. If you return home first and try to enter a skilled nursing facility later, Medicare can say that you no longer qualify.

Once these conditions are met, Medicare will pay the full cost of skilled nursing care for the first 20 days. This includes the cost of your room, meals, nursing care, physical therapy, medications related to your skilled treatment and medical supplies.

But starting on day 21, the cost-sharing rules change. Medicare still covers the care, but you owe a daily coinsurance amount. For days 21–100, you pay $209.50 each day in 2025. For days 101 and beyond, you pay all costs out of pocket.

What does Medigap do to cover those skilled nursing daily costs?

Most of the popular Medigap plans cover the full daily coinsurance for days 21 through 100 in a skilled nursing facility. Without Medigap, a month of skilled nursing facility coinsurance could easily cost thousands of dollars. With Medigap, that financial burden is gone and you can focus on recovery.

Many people buy Medigap for the hospital benefits, but the skilled nursing coverage is also very important. Skilled nursing care is extremely common for older adults recovering from illness or injury and knowing that your coinsurance is covered can give you peace of mind for you and your family.

But Medigap can only help if Medicare’s skilled nursing benefit is active. If Medicare denies the stay, then Medigap cannot pay anything. It can only supplement Medicare and not replace Medicare’s coverage.

This is why you must know all about the three-day hospital requirement and the admission requirements. A Medicare Supplement agency in Michigan City, Indiana can help you understand these rules and plan accordingly.

What are the costs Medigap can’t cover in skilled nursing care?

The biggest limitation is that Medigap does not pay for custodial care. Custodial care is long-term, non-medical assistance with everyday activities like bathing, dressing, eating, etc. This type of care is very common for people with dementia or mobility challenges. But because Medicare does not cover it, Medigap cannot cover it either.

This can be very confusing because skilled nursing facilities do provide both skilled and custodial services. But Medicare only pays for skilled care that helps you recover. Once you stop improving or no longer need skilled therapy, Medicare ends its coverage.

Another key limit is the 100-day cap. Medicare only covers skilled nursing facility care for up to 100 days per benefit period. Even if you are still sick or recovering after day 100, the benefit stops. Medigap cannot extend the limit or cover your room and board once Medicare stops paying.

This is why you need to do some planning with an expert. A licensed Medicare Supplement agency in Michigan City, Indiana can help you review your Medigap benefits and understand your Medicare rights. With their assistance, you can be prepared for the steps needed to qualify for skilled care if you ever need it.

Looking for a Medicare Supplement Agency in Michigan City, Indiana?

If you want someone to review your Medigap plan, or help you understand how skilled nursing coverage works, an experienced Medicare Supplement agency in Michigan City, Indiana can help. At Senior Care Insurance Services, our licensed agents can explain your benefits and help you plan for your future care needs. Contact us today to find the right option for you.