Insurance in a Skilled Nursing Environment

insurance skilled nursing - Southern Hills Nursing

Jessica Luckett
Social Services and Business Office
Southern Hills Skilled Nursing & Rehab Center

Coming into a facility can be very stressful. A new diagnosis could have landed a person into a facility and that is frightening in its own self. Being a person’s first time in a facility can also be scary as you might not know what to expect. To top all of this off, the finance burden can also be very stressful. Knowing what insurance a person has can be very beneficial. All insurances are different. There are managed cares, Medicare plans and Medicaid. They all pay differently. Some insurances cover everything at one hundred percent, others have copays starting on day 21 and others start on day 1. Secondary insurances can help pay whenever a person’s primary insurance doesn’t cover. Knowing what that insurance covers as well will benefit a person. Some secondary insurances cover everything that the primary insurance doesn’t cover. Other secondary insurances only covers a few days.

Making a phone call to speak with your insurance company can help answer some questions on what your coverage is and what they will cover at a skilled nursing facility. Knowing this information can ease a person’s mind and it will help to know what to expect to pay. When a person has met their max out of pocket, they do not owe a copay as everything has been met for the year.

A New Year

As a reminder, since the beginning of the year is approaching, a person’s max out of pocket starts back at zero. If a person is in the middle their copays, it would start on January 1 due to the max out of pocket starting over. Starting on January 1, 2022, Medicare copays are going up to $194.50. Other insurances could also be increasing their rates for copays as well since it is a new year. Hopefully by having this information, a person’s stay can be a little less stressful knowing what to expect financially.


There are even different types of Medicaid plans. Some policies will cover copays only. Some will pay for everything. Not all Medicaid plans will cover long term care or intermediate care either. This can become an issue when a person needs intermediate or long term care. Medicaid can be beneficial when a person cannot pay for their copays or their stay privately. The Medicaid process is not an easy one but it is a program that helps a person when they are eligible for it. When a person is long-term care under their Medicaid, a person will need to pay patient liability. Patient liability is a resident’s responsibility to the facility. This amount is based on a person’s income. Medicaid determines this amount. This amount is not determined by the facility. Medicaid will then cover the rest of a resident’s stay. With patient liability, it is a person’s income minus fifty dollars. The fifty dollars are for the resident to use for personal items. That could be ordering food, buying clothes or personal items or just letting it sit in their resident trust account to save it for a later time. A person can save their money as long as they do not exceed $2000. If a person does exceed that amount, then there is a chance that they could lose their Medicaid for being over resources. Medicaid can be very confusing but knowing how Medicaid works can benefit a person when picking out a Medicaid plan to see what will be covered and what is owed to the facility.

Reach Out

All insurances are different and can be very confusing. Reaching out to a person’s insurance and knowing what is owed and covered can help when coming into a facility. Reaching out to the facility’s business office can also help to ask questions but being informed prior will help with a person’s insurance is beneficial. This helps not just in a skilled nursing facility but also when it comes to what is owed for a hospital stay, doctor’s office visits and home health services.