Does Kaiser Cover Skilled Nursing Facilities? Days and Costs

Kaiser Permanente does cover skilled nursing facility care, but only when the stay meets specific medical criteria. A Kaiser plan physician must determine that you need daily skilled nursing or regular skilled rehabilitation that only licensed professionals can provide, and the facility must be on Kaiser’s approved list. When those conditions are met, most Kaiser Medicare Advantage plans pay for up to 100 days per benefit period. Custodial care, meaning help with bathing, dressing, eating, and similar daily tasks, is not covered.¹

Skilled Care vs. Custodial Care

The line Kaiser draws is clinical. Skilled care is nursing or rehabilitative service that must be delivered by, or under the supervision of, licensed professionals: registered nurses, physical therapists, occupational therapists, or speech therapists. IV therapy, tube feeding, complex wound care, and post-surgical rehabilitation are the usual examples.¹

Custodial care covers everyday living: bathing, dressing, eating, walking, taking oral medications. These don’t require licensed staff, and Kaiser does not pay for them. The exception is narrow and applies only to some members with Medi-Cal coverage through the plan. If a patient remains in a skilled nursing facility after the clinical need for skilled-level services ends, Kaiser generally will not keep covering the stay.¹

Assisted living, board-and-care homes, and ordinary long-term custodial nursing home care are not covered benefits. Kaiser’s own guidance states that “long-term care is generally not covered by Medicare or Kaiser Permanente.”² Kaiser may still cover discrete therapy sessions inside a custodial setting if those services are authorized by its Nursing Home Services team, even when the member is paying privately for the room.³

Who Qualifies and How Authorization Works

Four conditions have to line up at the same time. The member must meet Medicare’s skilled care criteria, need skilled nursing on a daily basis or skilled rehabilitation at least five days per week, use a facility on Kaiser’s approved list, and have the stay ordered by a Kaiser plan physician who finds it medically necessary.¹ Every placement requires prior authorization from a Kaiser care management representative.³

One important point of difference from Original Medicare: Kaiser does not require a prior three-day inpatient hospital stay before admitting you to a skilled nursing facility.⁴ Traditional Medicare Part A requires three consecutive inpatient hospital days first.⁵ Kaiser waives that requirement across its regions.¹

You also don’t need to be getting better to qualify. Under the standard set in the Jimmo v. Sebelius settlement, skilled care to maintain a condition or slow deterioration is covered, as long as the care genuinely requires professional-level services.⁴

How Many Days and What You Pay

Most Kaiser Medicare Advantage plans cover up to 100 days of skilled nursing facility care per benefit period. A benefit period starts the day you are admitted to a hospital or SNF at a skilled level and ends after 60 consecutive days without inpatient skilled care. There is no cap on the number of benefit periods, so a new 100-day allotment opens each time a new benefit period begins.¹

Out-of-pocket costs depend on your plan and region. The first 20 days are typically covered at no cost. After day 20, daily copays apply, and the amounts vary. A few examples from 2026 plan documents:

Southern California (Los Angeles and Orange Counties): $0 for days 1–20, then $100 per day for days 21–100.⁶
Northern California (Sacramento/Sonoma Basic): $0 for days 1–20, then $150 per day for days 21–100.⁷
Hawaii (Enhanced plan): $0 for days 1–20, $175 per day for days 21–40, then $0 for days 41–100.⁸
Georgia (Standard plan): $0 for days 1–20, then $218 per day for days 21–100.⁹

Original Medicare in 2026 charges $0 for days 1–20 and $217 per day for days 21–100, so several Kaiser plans sit at or below the traditional Medicare copay.⁵ Check your plan’s Evidence of Coverage or Summary of Benefits for the exact figures. Amounts differ meaningfully by region and plan tier.

Where You Can Go: Premier and Contracted Facilities

Kaiser contracts with an approved network and divides it into two tiers. Premier facilities are selected for quality and clinical coordination and are integrated with Kaiser’s electronic health record system, so the SNF team has direct access to the patient’s medical history, test results, and care plan. At a premier facility, a Permanente physician sees the patient at least weekly, and a Kaiser case manager is typically on-site.¹⁰

Contracted facilities are approved based on industry ratings, patient satisfaction surveys, and community feedback, but they don’t share the same system integration. Kaiser case managers aren’t based on-site and generally check in about three times per week rather than daily.¹¹

Most admissions go to a premier facility. A member may be placed at a non-premier contracted facility when a specialized service is only available there, or when no premier beds are open. The average stay runs about three weeks, and the Permanente physician works with the SNF care team to decide when the patient is ready for discharge.¹¹

If You Have Both Medicare and Medi-Cal

Dual-eligible members in California have access to broader benefits through Kaiser’s Dual Complete plan (HMO D-SNP), which covers Long-term Services and Supports. That includes help with everyday tasks like bathing, toileting, dressing, cooking, and medication management. These services are usually delivered at home or in the community, though they can also be provided in a nursing home.¹²

For dual-eligible members, Medi-Cal is the payer of last resort and covers copays, coinsurance, and deductibles that Medicare does not pay. Medicare providers cannot bill those cost-sharing amounts directly to dual-eligible patients and must bill the Medi-Cal health plan instead.¹³ Dual Complete members are also assigned a care coordinator who helps develop a personalized care plan and manages providers.¹²

After the 100 Days End

Once the 100-day benefit is used up, the member pays for any continued SNF stay. A new 100-day period becomes available after 60 consecutive days without inpatient hospital or skilled nursing care.⁵

Several alternatives can bridge the gap. Members who are homebound and have a physician’s order for skilled nursing or therapy at home may qualify for Kaiser home health services.¹⁴ On discharge, a Kaiser case manager can help arrange a home health nurse, a therapist, or rehabilitation equipment.¹¹ Home health through Kaiser covers skilled nursing, physical therapy, occupational therapy, speech therapy, and social services, typically at no charge for Medicare Advantage or Medi-Cal members. It does not cover custodial care, respite care, homemaker services, or long-term rehabilitation at home.¹⁵

Other paths include outpatient therapy, a private long-term care insurance policy if one is in place, and Medicaid for those with limited income and resources.

If Coverage Is Denied or Cut Short

When Kaiser decides a member no longer meets the criteria for skilled care, the facility must deliver a written Notice of Medicare Non-Coverage at least two days before covered services end. The notice has to state the end date, explain the right to appeal, and give contact information for the state’s Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).¹⁶

To challenge the decision, request a fast appeal from the BFCC-QIO no later than noon the day before coverage ends. The facility then has to provide a detailed written explanation of its reasoning by the close of that business day. The BFCC-QIO reviews the medical records and issues a decision by the close of business the day after it receives everything it needs.¹⁶

If the first appeal fails, a second-level review by a Qualified Independent Contractor must also be decided within 72 hours. A third level, a hearing before an Administrative Law Judge, can be requested within 60 days of the second denial, but it is not expedited and can take months.

Members may request copies of all documentation submitted during the appeal and can have their personal physician submit a written statement explaining why continued care is medically necessary. During the first two levels of appeal, the member can be financially responsible for the cost of the stay if the appeal is ultimately unsuccessful.¹⁷

1
Kaiser Permanente. A Guide to Skilled Nursing Facility Care for Kaiser Permanente Senior Advantage and Medicare Cost Members
2
Kaiser Permanente. Long-Term Care Staying Healthy
3
Kaiser Permanente Washington. Nursing Home Services Provider Manual
4
Kaiser Permanente. Clinical Review Skilled Nursing Facility Northwest
5
Medicare.gov. Skilled Nursing Facility Care
6
Kaiser Permanente. Summary of Benefits Los Angeles and Orange Counties 2026
7
Kaiser Permanente. Annual Notice of Changes Basic Sacramento Sonoma 2026
8
Kaiser Permanente. Annual Notice of Changes Enhanced Hawaii 2026
9
Content MedicareAdvantage.com. Kaiser Summary of Benefits Standard Plan Georgia 2026
10
Kaiser Permanente. Skilled Nursing
11
Kaiser Permanente. Skilled Nursing FAQ
12
Kaiser Permanente. Summary of Benefits Special Needs Dual Complete 2026
13
DHCS. SNF Notice of Action
14
Kaiser Permanente. Home Health Services
15
Kaiser Permanente. Home Health FAQ
16
Medicare.gov. Fast Appeals
17
Center for Medicare Advocacy. Self-Help Packet for Expedited Skilled Nursing Facility Appeals