Who pays for skilled nursing care: Medicare or you?

Who pays for skilled nursing care: Medicare or you? By Toni King Toni Says October 1, 2026 - 9:27 am Dear Toni: My husband, Steve, had exigency country successful January aft a fall. He was successful a skilled nursing installation for implicit 2 months, relearning however to walk. Since helium has lone archetypal Medicare, helium was billed implicit $1,700. The skilled nursing installation besides charged him implicit $8,000, and he’s paying this retired of his ain pocket. He did enroll successful a Medicare Part D program with a $0 monthly premium. Here’s his problem: Steve returned to the infirmary successful July for further country and had different circular of skilled nursing. There’s different out-of-pocket complaint of $1,700 for the July incidental due to the fact that Medicare says that’s different skilled nursing payment period. A Medicare typical advised him to enroll successful a Medicare Advantage program during the Oct. 15-Dec. 7 unfastened enrollment period. (The program would statesman Jan. 1.) Steve is confused astir what helium should bash and however to find the close Medicare Advantage plan. — Mary, Arlington, Texas Dear Mary: The 2026 “Medicare & You” handbook sets retired what Part A covers and what it doesn’t, explaining some inpatient infirmary attraction and skilled nursing benefits. For 2026, the Part A inpatient infirmary deductible is $1,736, paid six times a year. This means that the Part A deductible starts implicit each 60 days. (Steve’s $1,700 retired of pouch really was $1,736 per inpatient infirmary enactment successful January and July.) The 2026 Part A costs for a skilled nursing enactment are a $0 copay per time for days 1-20 and $217 per time for days 21-100. After Day 100, Steve is liable for 100 percent of his remaining enactment since helium does not person a Medicare supplement oregon a Medicare Advantage program to prime up the out-of-pocket cost. The 2026 Part B (medical/doctor) deductible of $283 began Jan. 1. After the deductible is met, Medicare pays 80 percent of the Medicare-approved magnitude and the beneficiary pays 20 percent. Steve could person immoderate out-of-pocket expenses with Part B due to the fact that of his aesculapian issues. Since helium is searching for the close Advantage plan, I would counsel him to consult his existent skilled nursing facility, aesculapian providers, aesculapian facilities and infirmary to find retired if they judge a definite program network. Because of Steve’s aesculapian issues, helium mightiness not beryllium capable to walk the aesculapian underwriting process to suffice for a Medicare supplement. That is wherefore I suggest helium enroll successful a Medicare Advantage program HMO oregon PPO. There is immoderate bully quality for Steve: Because helium has a stand-alone Part D plan, helium tin enroll successful a Medicare Advantage Part D program during the unfastened enrollment play without immoderate problems. His Part D program volition alteration to the Medicare Advantage Part D program helium has chosen. He tin telephone 800-633-4227 oregon spell to medicare.gov to enroll oregon telephone his chosen Advantage program directly. Toni King is an writer and columnist connected Medicare and wellness security issues. If you person a Medicare question, email oregon telephone 832-519-8664.