Your insurance verifier has just flagged a potential patient transfer from a hospital to your facility. Should they go to your skilled nursing unit or long-term care wing? What does skilled nursing mean in each type of facility? 

While both skilled nursing facilities (SNFs) and long-term care facilities provide essential care, they serve fundamentally different purposes.

SNFs focus on intensive, short-term medical care and rehabilitation, while long-term care facilities provide ongoing support for daily living activities. Knowing these differences is crucial for proper patient placement and reimbursement.

In this article, we'll cover:

• What a skilled nursing facility is

• Key differences between SNFs and LTC facilities

• Who qualifies for each type of care

• How Medicare, Medicaid, and private insurance cover SNF vs. LTC costs

This chart gives a detalied summary of an SNF vs. a llong-term care facility:

What is a skilled nursing facility (SNF)?

A skilled nursing facility is a specialized medical center that bridges the gap between hospital care and home. SNFs serve patients who need focused medical attention and rehabilitation but aren't sick enough to stay in the hospital.

Your medical team provides intensive, short-term care designed to help patients recover and return home.

SNFs provide:

• 24/7 medical supervision by registered nurses and licensed practical nurses who monitor vital signs, manage medications, and respond to medical emergencies
  
  

• Physical, occupational, and speech therapy services with specialized equipment and dedicated therapy spaces
  
  

• Complex wound care, IV therapy, and post-surgical care from trained medical professionals
  
  

• Specialized rehabilitation programs for stroke recovery, joint replacement, and cardiac conditions
  
  

• Regular assessments and care plan updates to track patient progress toward recovery goals

Who needs skilled nursing care?

Your skilled nursing admissions typically come directly from hospitals, often following major medical events or surgeries.

These patients need more intensive care than they can get at home or in an outpatient setting, but they don't require the full scope of hospital services. Most arrive with clear recovery goals and a plan to return home once they've regained their strength and independence.

Here are some common types of residents at an SNF:

• Short-term rehabilitation after a hospital stay for conditions like joint replacement, stroke, or cardiac events
  
  

• Ongoing medical supervision due to a serious illness or surgery requiring wound care or IV therapy
  
  

• Patients transitioning from ventilator care who need respiratory therapy and monitoring
  
  

• Those requiring intensive physical therapy to regain strength and mobility after an accident or illness
  
  

• Post-operative patients who need specialized care but aren't ready to return home

How long do patients stay at SNFs?

Most skilled nursing patients stay for a few weeks to a few months, with Medicare covering up to 100 days of care per benefit period. However, understanding Medicare's coverage timeline is crucial for your facility's billing and your patients' financial planning.

Here's how Medicare Part A coverage breaks down:

• Days 1-20: Medicare covers 100% of the cost.

• Days 21-100: Patients pay a daily copay of $209.50 (as of 2024).

• After Day 100: Patients are responsible for all costs.

But here's what you need to know about patient stays: The 100-day maximum isn't a guarantee. Medicare only continues coverage if patients demonstrate a need for skilled care and show progress toward their recovery goals.

Your team's documentation of this progress is essential for maintaining coverage.

A few key points about SNF stays:

• Patients must have a qualifying 3-day inpatient hospital stay before admission (though some Medicare Advantage plans waive this requirement).
  
  

• If a patient needs to return to the hospital and comes back to your facility within 30 days, they don't need another qualifying hospital stay.
  
  

• The clock resets on Medicare coverage if a patient has a 60-day break in skilled care, starting a new benefit period.
  
  

• Some Medicare Advantage plans may charge copayments during the first 20 days, unlike Original Medicare.

Now that we’ve discussed what skilled care is at these nursing facilities, let’s move on to what makes long-term care centers different.

What is long-term care (LTC)?

Long-term care facilities focus on supporting residents who need ongoing assistance with daily activities, often for months or years.

Unlike SNFs, which prioritize medical recovery and rehabilitation, LTC facilities create a home-like environment where residents receive consistent support and supervision. Your LTC facility becomes their primary residence, with care plans designed around comfort and quality of life rather than intensive rehabilitation.

LTC facilities provide:

• Daily living assistance with personal care needs like bathing, dressing, and eating
  
  

• Medication management and health monitoring by nursing staff
  
  

• Social activities and recreational programs to maintain mental wellbeing
  
  

• Nutritional support with specialized dietary plans and assistance during meals
  
  

• 24/7 supervision and safety monitoring
  
  

• Housekeeping and laundry services
  
  

• Transportation to medical appointments
  
  

• Memory care units with specialized programming for residents with cognitive decline

Who needs long-term care?

Long-term care residents often have complex needs that can't be met at home or in assisted living facilities. While they may not require intensive medical treatments, they need consistent professional care and supervision to maintain their safety and quality of life.

Unlike skilled nursing patients working toward discharge, LTC residents need ongoing support that may increase over time.

Long-term care is typically needed for:

• Seniors who can no longer live safely at home due to physical limitations or chronic conditions
  
  

• People with dementia, Alzheimer's disease, or other forms of cognitive decline who need 24/7 supervision
  
  

• Individuals with progressive conditions like Parkinson's disease who require increasing levels of assistance
  
  

• Those who lack the support system needed for safe independent living
  
  

• Residents whose care needs exceed what assisted living facilities can provide

The key difference from SNF care? These residents aren't working toward discharge goals — instead, your team focuses on maintaining their comfort and dignity while managing their ongoing care needs. 

How long do patients stay at LTCs? 

Unlike the short-term nature of skilled nursing care, long-term care residents typically stay for extended periods — often years. This fundamental difference affects everything from care planning to payment options.

Medicare doesn't cover long-term care stays. This is a crucial distinction from SNF care — while Medicare Part A covers up to 100 days of skilled nursing care, it won't cover custodial care in a long-term care setting.

Your residents will need to rely on:

• Medicaid (after qualifying through spend-down requirements)

• Private long-term care insurance

• Personal funds

• A combination of these payment sources

The duration of stays varies significantly:

• Most residents stay for multiple years

• Care needs often increase over time

• Transfers typically only occur if residents need acute medical care or specialized services not available at your facility

• Many residents remain in LTC for the remainder of their lives

Planning ahead for extended stays is essential. Your admissions team should help families understand their payment options and connect them with appropriate resources for financial planning. This might include guidance on:

• Medicaid application processes

• Available community resources

• Long-term care insurance benefits

• Options for subsidized care programs

Skilled nursing facility vs. long-term care: Key differences and billing considerations

SNFs face complex compliance requirements that directly impact reimbursement. Your team needs to track patient eligibility, maintain detailed documentation for Medicare, and ensure MDS assessments are accurate — all while focusing on patient care.

ExaCare's solution

ExaCare's AI-powered platform transforms your Medicare documentation and compliance process in several ways:

• Our system automatically screens referral packets to verify Medicare eligibility and confirm the required 3-day hospital stay, eliminating manual verification work.
  

• The platform integrates directly with hospital systems and referral sources, bringing all your documentation into one centralized hub.
  
  

• For admitted patients, ExaCare continuously monitors the length of stay and coverage periods, sending real-time alerts before Medicare coverage changes or ends. This helps your team avoid costly gaps in reimbursement and prepare patients for coverage transitions.
  
  

• The platform also streamlines financial assessments by automatically flagging high-cost medications and providing reimbursement estimates based on each patient's data.
  
  

• When patients transition between payment sources — like moving from Medicare to Medicaid coverage — ExaCare automates the documentation process to prevent billing delays, particularly with DME billing.
  
  

• ExaCare integrates seamlessly with your existing EHR systems like PointClickCare and WellSky, eliminating duplicate data entry and reducing administrative time.

Costs and insurance: How skilled nursing and long-term care are covered

Skilled nursing facilities and long-term care facilities have different payment structures based on the type of care provided. Understanding payment options is crucial for both your facility and your patients' families. 

Here's a clear breakdown of coverage options:

• Medicare coverage: For skilled nursing care, Medicare Part A covers the first 20 days completely, followed by a daily copay of $209.50 for days 21-100. However, Medicare won't cover long-term care at all — this is a critical distinction your admissions team needs to communicate clearly to families.
  
  

• Medicaid coverage: Medicaid becomes the primary payer for many long-term care residents once they meet eligibility requirements. For SNF patients, Medicaid may cover care after Medicare benefits expire. Your facility needs to help families navigate the application process early, as Medicaid approval can take several months.
  
  

• Private insurance: Private insurance coverage varies significantly. While many plans cover short-term skilled nursing stays, long-term care coverage typically requires a separate long-term care insurance policy. Verify coverage details before admission to avoid reimbursement surprises.
  
  

• Out-of-pocket costs: Patients often face significant out-of-pocket expenses, especially in long-term care where Medicare doesn't provide coverage. Families should understand their financial responsibility for copays, non-covered services, and room and board charges.

The key challenge: Billing for SNFs and LTC facilities is complex, especially with Medicare coverage limitations, Medicaid applications, and private insurance claims.

ExaCare's AI-powered platform screens referral packets and analyzes clinical and financial information in minutes, helping you make faster, more informed admissions decisions.

How to choose between a skilled nursing facility and a long-term care facility

Patient needs and coverage options drive the choice between skilled nursing and long-term care. While SNFs focus on short-term rehabilitation with Medicare coverage, LTC facilities provide ongoing support that often relies on Medicaid or private payment.

Here's what to consider when making this decision:

• Medical needs: Choose SNF care when the patient needs intensive rehabilitation or skilled medical services to recover from an acute condition. Long-term care is appropriate when the primary need is ongoing assistance with daily activities and supervision.

• Insurance and cost: Consider available coverage — Medicare for short-term skilled care, Medicaid for long-term care after qualifying, or private insurance options. Factor in the length of coverage and potential out-of-pocket expenses.
  
  

• Duration of stay: SNFs typically serve patients for weeks to months during recovery, while LTC facilities provide permanent or years-long residence. Your care team should help families plan for potential transitions between levels of care.

Can a patient transfer from SNF to LTC?

Yes, and it's a common transition when patients need ongoing care after their rehabilitation period ends. The key is planning ahead — your team should begin discussing long-term care options and Medicaid applications early if it appears a patient won't be able to return home after SNF care.

Simplify SNF and LTC billing with ExaCare

Hospital discharge planners need quick decisions about patient placements, but processing lengthy referral packets while evaluating clinical and financial fit can take hours of your team's time. Every minute spent manually reviewing documentation is a minute you could lose a referral to another facility.

ExaCare transforms your admissions process by using AI to streamline referrals, automate document review, and help you make faster, more informed decisions. Our platform helps you modernize your operations while maintaining the quality of care your facility is known for.

Here’s what we offer:

• Analyzing complex referral packets in minutes to extract key clinical and financial information
  
  

• Centralizing all your referral sources in one easy-to-use platform
  
  

• Identifying high-cost medications and potential reimbursement risks before admission
  
  

• Providing analytics to track referral relationships and response times
  
  

• Facilitating faster communication with hospital partners through a unified hub

We hope this guide answers your questions about what a skilled nursing facility is. Ready to see how ExaCare can help your facility win more referrals? Talk with our team to learn more.

Schedule a demo.