What costs $209.50 per day and also is terrible?

The answer is: coinsurance for skilled nursing when you have Medicare.

$209.50 per day.

That’s how much it costs for your parent to stay in a skilled nursing facility if they have Medicare. How much is that per month? More than $6,000.

I wanted to throw these numbers at you right away to sort of shock you into learning about something really boring but really important: health insurance for older adults. When I first started managing things for my dad, I had no idea how Medicare or Medicaid worked or who paid for what. In a moment, I’ll walk you through exactly what it cost when my dad was in “rehab” at a skilled nursing facility in 2020 and 2021. First, let’s get our terms straight.

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Throughout your working life, you pay a tiny tax each pay period, and that tiny tax funds a program called Medicare. Medicare is insurance for older adults, paid for by the government, partly by these taxes. Medicare is for people 65 and over, and other folks in certain circumstances. It’s often confused with Medicaid, which is for people of any age who are disabled or poor.

Medicare is broken up into parts: Part A is for coverage for hospital stays, Part B is for medical coverage (like visits to specialists), Part D is for prescription drugs. Most people have worked long enough (about 10 years) and paid enough taxes that they don’t have to pay a premium for Part A. Part B costs, for most people, about $185 per month.

You can also opt out of traditional Medicare and go with a private company that provides so-called Part C, a Medicare Advantage Plan, which includes both Part A and Part B and usually part D. Often, the premium for a Medicare Advantage Plan is lower than $185, but you have to stick with the doctors, hospitals, and providers that are “in-network.” You may also need supplemental insurance to cover the cost of coinsurance.

My dad mostly managed his own health care coverage independently until he started getting hospitalized and sent to rehab frequently. Then, I suddenly needed to help him navigate these various systems. I wish I had understood them earlier.

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To all my friends who still have one or both parents, there’s one especially important thing you need to know about Medicare. It’s this: Medicare does not cover long-term nursing home stays. If your parent is on Medicare, and odds are, they are or they will be, Medicare will not pay for them to go to a nursing home.

It’s Medicaid that pays about 60 percent of all long-term care costs in Florida. Medicare pays about 19 percent, according to the Florida Health Care Association. I know this is confusing, because I just said that Medicare will not pay for nursing home stays. It doesn’t! What it does pay for are temporary stays in skilled nursing facilities.

If your parent falls, for example, and is hospitalized for at least three days, and then is unable to return home and must receive physical therapy in a skilled nursing (“rehab”) setting, Medicare will pay for that. For about three weeks.

Medicare will pay for days 21-100, too, but you must also toss in a coinsurance payment, the amount of which is set by the government. In 2025, it’s $209.50. So on days 21-100, your parent owes $209.50 per day. After 100 days in a skilled nursing facility, Medicare no longer pays anything, so you must cover all costs on your own.

The average cost of nursing home care across the country per day is about $305. (It varies wildly by state, as you might imagine.) You think the cost of your daily $6 latte adds up quickly?

To pay for coinsurance, perhaps your parent signed up for a Medigap policy, also called supplemental Medicare. That’s great! It will probably enable them to stick with their current doctor and help with coinsurance and other costs. Medigap policies can cost around $200 a month or more (here’s a calculator), depending on your parent’s health, age, pre-existing conditions, and ZIP code. Some pay for skilled nursing, and some don’t. Ask your parent if they know which supplemental policy they have, and take a look at the coverage when you can.

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I think it will be helpful to talk through exactly what happened with my dad.

My dad was enrolled in a Medicare Advantage plan (now called “Medicare Part C”). He liked his Medicare Advantage Plan because it had a $0 premium and he got to select something like $100 in over-the-counter items each month. “Do you need a toothbrush?” he’d ask me, trying to burn through that $100 like a kid with a fresh allowance at the candy store. He amassed dozens of bottles of generic Tylenol, bandages in every size, and enough flimsy white dental floss to circle the planet.

About a year before he died, my dad doubled over with a sharp pain in his abdomen. He went by ambulance to the hospital and underwent emergency surgery for appendicitis. The Medicare Advantage Plan covered his hospital stay, which cost in the hundreds of thousands. He was discharged from the hospital to a skilled nursing facility for rehab, and the Medicare Advantage Plan paid for his first 20 days. Note that Medicare only pays for skilled nursing if you’re discharged from the hospital after staying at least three days (a “qualifying stay”).

My father and my little family celebrating Christmas outside the facility where he was staying in December 2020.

My father fell while he was at the facility, and was readmitted to the hospital, where they discovered he had a UTI. Falling and being readmitted to the hospital (for a different condition) restarted the clock, so Medicare paid for an additional 20 days at a new facility with no coinsurance. After day 20 at the second facility, though, we had to pay about $200 per day in coinsurance.

If you’re keeping score at home, that means for days 21-100, we owed about $16,000.

And he still wasn’t ready to come home. To pay for day 101, we had to figure out how to qualify for Medicaid.

When you’re trying to figure this out, you’re probably dealing with immense pressure, or at least I was. I needed to get my dad into a new facility. I needed a way to pay for it. Immediately.

If you’re not urgently trying to get your parent into a facility, weighing your healthcare options and applying for Medicaid may be well within your executive functioning capabilities. But trust me––the stress of dealing with a parent who is ill, on top of your other responsibilities, is a gigantic strain on your executive functioning.

Enrolling in Medicaid when your parent is ill is like being told you need to start a bicycle scavenger hunt after you finish running a marathon. Your legs are already Jell-O, you don’t know where to start, and you have to pedal around town guessing where the clues are leading you.

The way we finally got my dad on Medicaid was that he was in a facility and the business office person connected us with a Medicaid person who filled out all the forms for us. She told me exactly what documentation I needed to provide, and then she submitted everything through some magic system to which the average person either doesn’t have access or cannot find.

She was very motivated to help us because we had run out of money. This is how your parent goes from having a significant amount of savings to being on Medicaid, the government health insurance program that is, ostensibly, for the poor.

The thing is, Medicaid is not just for the poor. It’s for the people who have been MADE poor by the system under which we care for our elderly.

What happens to a lot of people, and what happened to my dad, is that they spend down their savings by paying out of pocket for skilled nursing care, as they are hoping to receive the necessary therapy to allow them, eventually, to return home. They pay for days on days on days in rehab, getting maybe 20 minutes at a time of the therapy they need to be able to live independently. And then the skilled nursing facility wants to be paid, so they help you enroll your parent in Medicaid.

Every year, your parent must reapply for Medicaid, undergoing a process called “redetermination.” During the height of the pandemic, this was suspended, and no one was forced to go through the redetermination process, and no one was kicked off Medicaid. That ended in Florida in March 2023.

There were many times when I tried to figure these things out on my own and ended up frustrated and in tears. And I am good at researching things! I have two master’s degrees, one in strategic communication, and have worked not only as a journalist but as a trainer of journalists. It is simply not designed to be easy to navigate. I am convinced that this is intentional, that the state of Florida makes it hard to apply for Medicaid, makes it hard to understand redetermination, makes it impossible to plan for skilled nursing costs, because the people who run the state do not want its citizens to be able to obtain coverage. They do not want to care for people.

What can you do?

Work with an elder law attorney and financial adviser while your parent is healthy. There may be ways to safeguard some of your money and still qualify for Medicaid or to invest in a way that allows them to pay for long-term care. Doing this without a lawyer is not advisable. If your parent gives away assets in preparation for Medicaid eligibility, their Medicaid eligibility may be delayed, as the state may “look back” five years to check eligibility. Again, protecting your parent’s assets may be possible, but you need a lawyer. While you’re talking to your new elder law attorney, discuss becoming your parent’s power of attorney and health care surrogate if you haven’t already done so.

If your parent is still under 65, consider long-term care insurance. If they’re unlikely to be able to afford care out of pocket (remember, about $300 a day on average!), and unlikely to qualify for Medicaid without first losing a ton of money “spending down,” the monthly premiums might be worth it. After age 65, your parent might end up getting rejected by the insurance companies or owing an exorbitant premium that makes it not worth it. I honestly wish we had looked into this when my dad was in his 60s, but it’s very hard to plan ahead. When my dad was 60, I was just 18, and we thought for sure he would die in a spontaneous cardiac event (we were pretty sure he’d have a heart attack.) Life comes at you fast, as they say.

Ask your parent to ask their friends what their plans are for long-term care. Normalizing the conversation and keeping it top of mind will help everyone prepare for the logistics of what’s next.

Share information with your parent about Medicaid, average costs, spending down. All of this was new to us when we got into this situation, and my dad never fully understood the financial implications of the choices we faced. Becoming literate about these topics before they impact your family specifically will allow you to make better choices down the line.

Gather your parent’s documents and be sure you have access to important financial records. How much does your parent receive in Social Security benefits? Where is their benefits letter? Do they have long-term care insurance? A pension? How many savings accounts do they have? Do you have access to them?

Work with the business office of the facility to explore options and apply for Medicaid, if you get to that point, as we did. Ideally, you have worked with an elder law attorney ahead of time, instead, but this is the next best choice. It is very hard (for me, it was impossible) to navigate these systems without help from the inside.