Skilled Nursing Facility (SNF) - TRICARE Glossary | TRICARE.com

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## Definition A Skilled Nursing Facility (SNF) is an inpatient healthcare institution that provides 24-hour medically necessary nursing care and rehabilitation services for patients who do not require a hospital stay but cannot be safely managed at home.

## What it means in practice For TRICARE beneficiaries, a Skilled Nursing Facility (SNF) serves as a bridge between a hospital stay and returning home. TRICARE typically covers SNF care if it is medically necessary, the patient has a qualifying hospital stay (usually three consecutive days, though this can be waived for TRICARE Prime beneficiaries), and the care required can only be provided by professional or technical personnel. Common services include physical therapy, intravenous injections, and wound care.

Under the current T-5 contract, your regional contractor—**Humana Military** in the East or **TriWest Healthcare Alliance** in the West—manages the authorization process. Most SNF stays require prior authorization. TRICARE covers up to 100 days per "spell of illness," provided the patient continues to require a skilled level of care. If care shifts from "skilled" (rehabilitative) to "custodial" (assistance with daily living like bathing or eating), TRICARE coverage ends, as TRICARE does not pay for long-term custodial care.

Costs for SNF stays depend on your plan and sponsor status. For example, in **2026**, TRICARE Reserve Select (TRS) and TRICARE Select Group B retirees typically pay a daily copayment (e.g., approximately $25–$60 per day, though rates vary by plan year), while TRICARE Prime active duty family members often have a $0 copay if the stay is authorized. Always verify the current daily rate for the 2026 plan year with your regional contractor before admission.

If you are dual-eligible for Medicare and TRICARE (TRICARE For Life), Medicare acts as the primary payer for the first 20 days at 100%. From days 21 to 100, Medicare requires a daily coinsurance, which TRICARE For Life typically covers in full, leaving the beneficiary with $0 out-of-pocket costs for authorized skilled care.

## Related terms * **Custodial Care:** Non-medical care that helps with activities of daily living (bathing, dressing, eating), which TRICARE generally does not cover. * **Prior Authorization:** A requirement to get approval from Humana Military or TriWest before receiving SNF services to ensure coverage. * **Spell of Illness:** A period of time used to track SNF benefit limits, usually beginning upon hospital admission and ending when the patient hasn't received SNF or hospital care for 60 consecutive days. * **Medical Necessity:** The standard used by TRICARE to determine if a service is required to treat a specific illness or injury according to accepted medical practice. * **T-5 Contract:** The fifth generation of TRICARE managed care contracts, which transitioned the West Region to TriWest Healthcare Alliance on January 1, 2025.

## Sources * TRICARE.mil: Skilled Nursing Facility Care (https://www.tricare.mil/CoveredServices/IsItCovered/SkilledNursingFacilityCare) * TRICARE Manuals: SNF Reimbursement (https://manuals.health.mil/) * TriWest Healthcare Alliance: Provider Resources (https://www.triwest.com)