Medicare Open Enrollment and Skilled Nursing Coverage: A 2026 Guide for Rockford, IL Families

Published: December 2025 | Alpine Fireside Health Center, Rockford, Illinois

If you're a Rockford-area family with a loved one needing skilled nursing care, understanding Medicare coverage can feel overwhelming—especially during the annual open enrollment period. At Alpine Fireside Health Center, located at 3650 N Alpine Road in Rockford, IL, we work with families throughout Northern Illinois every day to navigate Medicare's complex rules, coverage limits, and payment options for skilled nursing care.

Whether you're transitioning from Javon Bea Hospital, UW Health Hospital, or OSF St Anthony Medical Center, or planning ahead for potential future needs, this comprehensive guide will help Rockford families understand exactly what Medicare covers—and what it doesn't—when it comes to skilled nursing care in 2026.

What is Medicare Open Enrollment? Important Dates for Rockford Residents

Medicare Open Enrollment, also called the Annual Enrollment Period (AEP), runs from October 15 through December 7 every year. During this window, Rockford-area Medicare beneficiaries can make important changes to their coverage that take effect January 1, 2026.

What you can do during open enrollment:

• Switch from Original Medicare to Medicare Advantage (or vice versa)
• Change from one Medicare Advantage plan to another
• Join, drop, or switch Medicare Part D prescription drug plans
• Add or drop a Medigap (Medicare Supplement) plan in certain circumstances

For families in Rockford, Loves Park, Belvidere, and throughout Winnebago County, these decisions directly impact how much you'll pay for skilled nursing care in 2026 if your loved one needs rehabilitation services or long-term care at facilities like Alpine Fireside Health Center.

Understanding Medicare Coverage for Skilled Nursing Care in Rockford, IL

Medicare covers skilled nursing care under specific conditions, and understanding these rules is crucial for Rockford families planning for care needs. Many families we work with at our North Rockford facility assume Medicare covers all nursing home costs—unfortunately, that's not the case.

What is "Skilled Nursing Care" Under Medicare?

Skilled nursing care means services that can only be performed safely and correctly by licensed nursing staff or therapists. At Alpine Fireside Health Center in Rockford, this includes:

• Intravenous (IV) injections and medications
• Wound care and dressing changes
• Physical therapy for rehabilitation after surgery or injury
• Occupational therapy to regain daily living skills
• Speech therapy after stroke or other neurological events
• Monitoring of serious medical conditions
• Tube feeding and specialized nutrition support
• Respiratory therapy and ventilator care

Families transitioning from Rockford hospitals—particularly those discharged from Javon Bea Hospital, UW Health Hospital, or OSF St Anthony Medical Center—often need these skilled services during the recovery period.

Medicare Part A: The 100-Day Coverage Rule

Medicare Part A provides the primary coverage for skilled nursing care in Rockford and throughout Northern Illinois. Here's exactly how it works in 2026:

Days 1-20: Fully Covered

• Medicare pays 100% of approved costs
• No copayment or deductible for these days
• This applies at Medicare-certified facilities like Alpine Fireside Health Center in Rockford

Days 21-100: Coinsurance Required

• Medicare pays most costs, but you pay a daily coinsurance
• 2026 coinsurance: approximately $200 per day (subject to annual adjustment)
• Medigap or Medicare Advantage plans may cover this coinsurance
• For Rockford families, this means approximately $16,000 in potential out-of-pocket costs for days 21-100

After Day 100: No Medicare Coverage

• Medicare Part A coverage ends completely
• Families must use other payment sources (Medicaid, private pay, long-term care insurance)
• This is when many Rockford-area families contact our team at Alpine Fireside to discuss Medicaid planning

Strict Requirements: What You Must Know Before Medicare Covers Skilled Nursing in Rockford

Medicare doesn't automatically cover skilled nursing care just because someone needs it. Rockford families must meet ALL of these requirements:

Requirement #1: 3-Day Prior Hospital Stay

Your loved one must have been admitted to a hospital (not just emergency room observation) for at least 3 consecutive days before transferring to skilled nursing care.

Important for Rockford families: If your loved one was discharged from Javon Bea Hospital, UW Health Hospital, or OSF St Anthony Medical Center, verify they were actually "admitted" rather than under "observation status." Observation doesn't count toward the 3-day requirement, even if they stayed in the hospital for 3+ days.

Requirement #2: Transfer Within 30 Days

Admission to a skilled nursing facility like Alpine Fireside Health Center must occur within 30 days of hospital discharge. Delays beyond 30 days typically result in Medicare denying coverage.

Requirement #3: Same Condition or Related Condition

The skilled nursing care must be for the same condition that required hospitalization, or a condition related to it. For example, if your Rockford family member was hospitalized for a hip fracture, Medicare covers skilled nursing for hip rehabilitation—not for an unrelated memory care need.

Requirement #4: Doctor Certification of Medical Necessity

A physician must certify that your loved one needs skilled nursing care on a daily basis. At Alpine Fireside in Rockford, our medical director works closely with your loved one's physician and hospital discharge planners to ensure proper documentation.

Requirement #5: Medicare-Certified Facility

The skilled nursing facility must be Medicare-certified. Alpine Fireside Health Center at 3650 N Alpine Road in Rockford is fully Medicare-certified and maintains a 5-star CMS rating, ensuring the highest quality of care for Northern Illinois families.

What Medicare Does NOT Cover: Common Misconceptions for Rockford Families

Many families in the Rockford area are surprised to learn what Medicare doesn't cover when it comes to nursing home care:

❌ Custodial Care: If your loved one only needs assistance with bathing, dressing, eating, or toileting (Activities of Daily Living), Medicare does not cover this. This type of care requires other payment sources.

❌ Long-Term Care: Medicare is designed for short-term rehabilitation, not long-term custodial care. Most Rockford residents in nursing homes for Alzheimer's or dementia care are using Medicaid or private pay, not Medicare.

❌ Room and Board Beyond Skilled Care: Once skilled nursing services are no longer medically necessary, Medicare coverage ends even if your loved one still needs supervision or assistance.

❌ Private Rooms: Medicare covers semi-private rooms. If you prefer a private room at our Rockford facility, you'll pay the difference out-of-pocket.

❌ Personal Items: Phone service, television, personal care items, and similar expenses are not covered by Medicare at skilled nursing facilities in Rockford or anywhere else.

Medicare Part B Coverage for Skilled Nursing: Outpatient Services in Rockford

While Part A covers inpatient skilled nursing facility stays, Medicare Part B covers certain outpatient services that Rockford residents might need:

Part B covers at skilled nursing facilities:

• Doctor visits while you're a resident at Alpine Fireside Health Center
• Outpatient physical therapy, occupational therapy, and speech therapy
• Diagnostic tests (X-rays, lab work, etc.)
• Medical equipment (walkers, wheelchairs, etc.)
• Some preventive services

Part B typically requires 20% coinsurance after you meet your annual deductible ($240 in 2026). For Rockford-area residents with Medigap plans, this coinsurance is usually covered.

Medicare Advantage Plans vs. Original Medicare: What Works Best for Rockford Families?

During open enrollment, many Rockford residents wonder whether Original Medicare or Medicare Advantage is better for potential skilled nursing needs. Here's what families should know:

Original Medicare (Parts A & B)

Advantages for Rockford residents:

• Freedom to choose any Medicare-certified facility in Northern Illinois, including Alpine Fireside
• No referrals needed
• Consistent coverage rules nationwide
• Can add Medigap to cover coinsurance and deductibles

Considerations:

• Same 100-day limit applies
• Days 21-100 coinsurance (~$200/day) unless you have Medigap
• No coverage after day 100

Medicare Advantage Plans

Many Rockford-area residents have Medicare Advantage plans through insurance companies. These plans must provide at least the same coverage as Original Medicare, but they often have different rules:

Potential advantages:

• May have lower or zero coinsurance for days 21-100
• Some plans cover additional days beyond 100
• Often include prescription drug coverage (Part D)
• May offer extra benefits like dental or vision

Important limitations for Rockford families:

• Must use in-network facilities (verify Alpine Fireside is in-network)
• May require prior authorization for skilled nursing
• Coverage can vary significantly between plans
• Network restrictions can limit facility choice in Northern Illinois

Critical question for Rockford residents: Before choosing a Medicare Advantage plan during open enrollment, verify that your preferred skilled nursing facilities—including Alpine Fireside Health Center at 3650 N Alpine Road—are in the plan's network.

Medigap (Medicare Supplement Insurance): Covering the Gaps in Rockford

Medigap plans, sold by private insurance companies, help Rockford residents pay for out-of-pocket costs that Original Medicare doesn't cover.

For skilled nursing care, Medigap can cover:

• Plans C and F: Cover the full Part A coinsurance for days 21-100 (approximately $16,000 in value)
• Plan G: Covers Part A coinsurance after you pay the Part A deductible
• Plan N: Covers Part A coinsurance with a $50 daily copay

Important for new Rockford Medicare beneficiaries: Plans C and F are no longer available to people who became Medicare-eligible after January 1, 2020. If you're a newer beneficiary in the Rockford area, Plan G is typically the best option for comprehensive skilled nursing coverage.

What Happens After Day 100? Options for Rockford Families

When Medicare coverage ends at day 100, Rockford families face important decisions. At Alpine Fireside Health Center, we help families throughout Northern Illinois navigate these options:

Option 1: Medicaid Coverage

Medicaid covers long-term skilled nursing care for eligible Illinois residents who meet income and asset requirements. Our Rockford team works with families to understand Medicaid planning and application processes.

Benefits for Rockford residents:

• Covers custodial and skilled nursing care indefinitely
• Alpine Fireside Health Center accepts Illinois Medicaid
• May allow your loved one to stay at the same Rockford facility they've been receiving care

Option 2: Private Pay

Families with sufficient resources can pay privately for continued care at Alpine Fireside. Current rates for skilled nursing care in the Rockford area typically range from $250-$400 per day depending on the level of care needed.

Option 3: Long-Term Care Insurance

Some Northern Illinois residents have long-term care insurance policies that cover skilled nursing costs after Medicare benefits exhaust. Review your policy to understand coverage limits and requirements.

Option 4: Return Home with Home Health Care

If your loved one has improved sufficiently, returning home with home health services (covered by Medicare Part A under certain conditions) might be an option for Rockford families.

2026 Medicare Changes That Affect Skilled Nursing Coverage

Rockford residents should be aware of these important updates for 2026:

Premium Changes:

• Part A premium: Most don't pay this (covered by payroll taxes)
• Part B standard premium 2026: $185 per month (estimate, subject to official announcement)
• Higher earners in Rockford and throughout Illinois may pay more based on income

Deductible Changes:

• Part A deductible 2026: $1,676 per benefit period (up from $1,632 in 2025)
• Part B deductible 2026: $240 annually (up from $240 in 2025)

Coinsurance Updates:

• Days 21-100 skilled nursing coinsurance: Approximately $200+ per day in 2026
• Exact amount announced by CMS in November

Common Questions from Rockford Families About Medicare and Skilled Nursing

Q: Can my loved one go back to the hospital and restart the 100-day Medicare clock?

A: Yes, but specific rules apply. If your loved one is discharged from Alpine Fireside Health Center in Rockford, goes at least 60 consecutive days without skilled nursing facility care, then gets hospitalized again for 3+ days, a new benefit period begins and Medicare coverage restarts at day 1.

Alternatively, if they're readmitted to a hospital for 3+ days after receiving skilled nursing facility care (without waiting 60 days), they may qualify for a new benefit period depending on the circumstances.

Q: What if Medicare denies coverage at a Rockford skilled nursing facility?

A: You have the right to appeal. At Alpine Fireside Health Center, our Rockford team helps families understand denial reasons and supports the appeals process. Common reasons for denial include:

• Hospital stay was observation status, not admission
• Care no longer requires skilled nursing (deemed custodial)
• Transfer occurred more than 30 days after hospital discharge
• Condition is unrelated to hospital stay

Q: Does Medicare cover therapy at skilled nursing facilities in Rockford?

A: Yes, if therapy is part of your skilled nursing care plan. Medicare covers physical therapy, occupational therapy, and speech therapy when medically necessary as part of your recovery. However, once you no longer need skilled care—meaning you've plateaued or no longer show improvement—Medicare coverage ends even if you still benefit from therapy.

Q: Can I choose Alpine Fireside specifically, or does Medicare assign facilities?

A: With Original Medicare, Rockford residents can choose any Medicare-certified skilled nursing facility, including Alpine Fireside Health Center at 3650 N Alpine Road. However, if you have a Medicare Advantage plan, you must verify that Alpine Fireside is in your plan's network.

Q: What happens if my loved one improves and no longer needs skilled care before day 100?

A: Medicare coverage ends when skilled care is no longer medically necessary, even if it's before day 100. Many Rockford families transitioning from Javon Bea Hospital, UW Health Hospital, or OSF St Anthony Medical Center complete their rehabilitation in 30-45 days. At that point, if they still need assistance but not skilled nursing, families explore other options like assisted living, memory care, or returning home with support.

Working with Hospital Discharge Planners: A Guide for Rockford Families

If your loved one is currently at Javon Bea Hospital, UW Health Hospital, or OSF St Anthony Medical Center in Rockford, the hospital discharge planner is your key resource for:

• Verifying the 3-day admission requirement was met
• Understanding Medicare coverage for your specific situation
• Getting referrals to Medicare-certified skilled nursing facilities in Northern Illinois
• Coordinating transfer to Alpine Fireside Health Center if desired
• Ensuring proper documentation for Medicare coverage

Pro tip for Rockford families: Don't wait until the day of discharge to start this conversation. As soon as your loved one is stable, begin discussing post-hospital care options with the discharge planner to ensure a smooth transition to skilled nursing care.

Why Alpine Fireside Health Center? Medicare Excellence in Rockford

Families throughout Rockford, Loves Park, Belvidere, and Northern Illinois choose Alpine Fireside Health Center at 3650 N Alpine Road for skilled nursing care because:

Medicare Certification & 5-Star Rating:

• Fully Medicare-certified skilled nursing facility
• 5-star CMS rating demonstrates exceptional quality of care
• Over 50 years serving the Rockford community

Seamless Hospital Transitions:

• Direct coordination with Javon Bea Hospital, UW Health Hospital, and OSF St Anthony Medical Center discharge teams
• Experienced admissions staff who understand Medicare requirements
• Same-day or next-day admission available for qualifying patients

Comprehensive Rehabilitation Services:

• On-site physical therapy, occupational therapy, and speech therapy
• Partnership with HealthPRO Heritage for specialized therapeutic services
• State-of-the-art rehabilitation equipment and techniques

Insurance & Payment Expertise:

• Dedicated staff to verify Medicare coverage before admission
• Help with Medicaid applications when Medicare coverage ends
• Transparent communication about coverage and costs
• Work with all major Medicare Advantage plans serving Rockford

Planning Ahead: What Rockford Residents Should Do During Open Enrollment

Even if you don't currently need skilled nursing care, Rockford-area Medicare beneficiaries should consider these factors during the October 15 - December 7 open enrollment period:

Review your current coverage:

• Understand your current plan's skilled nursing benefits
• Check which Rockford and Northern Illinois facilities are in-network
• Verify if prior authorization is required for skilled nursing
• Understand your out-of-pocket costs for days 21-100

Consider adding or changing Medigap:

• If you have Original Medicare and no Medigap, the days 21-100 coinsurance (~$16,000) comes out-of-pocket
• Medigap plans C, F (if eligible), or G can save Rockford families significant money if skilled nursing is needed
• Note: Outside of specific enrollment periods, Medigap companies can deny coverage based on health

Compare Medicare Advantage options:

• Some Medicare Advantage plans in the Rockford area have lower coinsurance for skilled nursing
• Verify Alpine Fireside Health Center is in-network before switching
• Consider whether limited facility choice is worth potential savings

Document your preferences:

• Let family members know which Rockford-area skilled nursing facilities you prefer
• Ensure someone has your Medicare card and insurance information
• Consider advance directives and healthcare power of attorney

Resources for Rockford-Area Medicare Beneficiaries

National Resources:

• Medicare.gov: Official Medicare website with plan comparison tools
• 1-800-MEDICARE: 24/7 helpline for Medicare questions
• Social Security Administration: 1-800-772-1213 for Medicare enrollment

Local Rockford Resources:

• Illinois Senior Health Insurance Program (SHIP): Free Medicare counseling for Illinois residents
• Area Agency on Aging: Winnebago County resources for seniors
• Alpine Fireside Health Center: (815) 877-7408 - Call for Medicare coverage questions

Hospital Social Services (Rockford):

• Javon Bea Hospital - Discharge Planning
• UW Health Hospital - Care Coordination
• OSF St Anthony Medical Center - Social Services Department

Conclusion: Making Informed Medicare Decisions for Skilled Nursing Care in Rockford

Understanding Medicare coverage for skilled nursing care doesn't have to be overwhelming for Rockford families. By knowing the 100-day rule, the strict qualifying requirements, the difference between Medicare Advantage and Original Medicare, and when supplemental coverage makes sense, you can make informed decisions during open enrollment that protect your family financially.

At Alpine Fireside Health Center, located at 3650 N Alpine Road in Rockford, IL 61114, we're here to help Northern Illinois families navigate Medicare coverage, verify benefits, and provide exceptional skilled nursing care when you need it most. Whether you're planning ahead or facing an immediate need after hospitalization at Javon Bea Hospital, UW Health Hospital, or OSF St Anthony Medical Center, our experienced team is ready to support your family every step of the way.

Questions about Medicare coverage for skilled nursing care in Rockford? Call Alpine Fireside Health Center at (815) 877-7408 or visit us at alpinefireside.com.