Medicare Coverage

Insurance provides safety and security against loss on a particular event. You have to have it. And most, over the age of 65 have coverage of Medicare. But what exactly does it cover? Do you know what it covers concerning skilled nursing facilities? Let’s go through a Medicare run-down!

Medicare Part A (Hospital Insurance) covers skilled nursing care (often known as rehabilitation) provided in a skilled nursing facility (SNF) under certain conditions for a limited time.

Medicare-covered services (if needed to meet your health goal) include, but are not limited to:

  • Semi-private room (or private room if the facility has no extra fees)

  • Meals

  • Skilled nursing care

  • Physical and occupational therapy

  • Speech-language pathology services

  • Medical social services

  • Medications (most)

  • Medical supplies and equipment used in the facility (most)

  • Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF (such as dialysis)

  • Dietary counseling

Eligible for these benefits if you meet these conditions:

  • You have Part A and have days left in your benefit period

  • You have had a qualifying hospital stay (3 nights)

  • You doctor has decided that you need skilled nursing care

  • You receive the skilled services in a SNF that is certified by Medicare

  • You are going to receive the skilled services for a condition you were hospitalized for or for a condition that started while you were getting care in the SNF for the hospital-related condition

**To be considered a 3-night hospital stay, your stay has to be defined at INPATIENT. Clarify with your case manager if you are in the hospital for observation or inpatient.

Costs:

  • Days 1-20 = $0 for each benefit period

  • Days 21-100 = $161 each day in the SNF unless your co-insurance pays some of this

  • Days 101 and beyond = you pay all costs.

EXTRAS:

  • If you have had a 3-night qualifying hospital stay, but do not immediately choose to go to a SNF for rehab, you have 30 days to change your mind and receive care

  • If your break in skilled nursing care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care

  • If your break in care lasts more than 60 days in a row, this ends your current benefit period and renews your SNF benefits

Nursing Home Care

Medicare Part A (Hospital Insurance) may cover care given in a certified skilled nursing facility (SNF) if it's medically necessary for you to have skilled nursing care. However, most nursing home care is custodial care (help with bathing, eating, dressing). Medicare doesn't cover custodial care if that's the only care you need. For more information, visit www.medicare.gov.

For more information visit "Your Medicare Coverage." Skilled Nursing Facility (SNF) Care. <https://www.medicare.gov/coverage/skilled-nursing-facility-care.html>.

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