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Skilled Nursing Facility Pricing Lacks Standard

“Medicare pays for our short-term skilled nursing facility (SNF) stays, but why does my friend get a private room when I can only have a semi-private room?”

If you have asked this or similar question, you are not alone. There is no industry standards to SNF pricing and benefit schemes, which cause unneeded confusion to patients and their caregivers in an already stressful SNF selection process.

So, does Medicare cover private room costs at a SNF?

If you qualify for Medicare coverage of your SNF stay, you are entitled to “at least” a semi-private room. You won’t find the “at least” qualifier in the published Medicare benefits because it is ultimately the SNFs’ prerogative to provide you an upgraded room (e.g., a private room). For example, some SNFs may provide a private room to Medicare patients at no out-of-pocket costs while other SNFs may allow the patients to buy-up to a private room (e.g., paying the cost difference between a private room and a semi-private room).

While the practice varies from one SNF to another, Medicare reimburses SNFs the same amount (before adjustment for geographic and severity differences) regardless of whether a patient is offered a private room or a semi-private room.

To help you make a more informed choice, be sure to ask and understand the pricing and services included during your SNF visits.