Skilled Nursing Facility Coverage
When your care needs are extensive and going home isn’t likely to be your first option, you may have questions about skilled nursing facility Medicare coverage. Does Medicare cover a skilled nursing facility?
The short answer is yes, but there are numerous limitations and restrictions. There are allotted benefit periods for this level of care. If your situation falls within these levels, you are likely to have coverage.
Additionally, there are specific requirements that are generally acceptable for coverage eligibility:
You must first be in a hospital for at least three days due to an illness or injury
While in the hospital, you must be considered inpatient; that is, you must have a medical need that requires you to remain in the hospital for at least three days.
When you are discharged from the inpatient setting, your doctor must write orders for ongoing care. Your doctor must state you need additional care in a skilled nursing home.
How Long Will Medicare Pay For Skilled Nursing?
Your coverage amount depends on the length of your stay. How much will Medicare pay for a nursing home, then? From the point of discharge from a hospital, it provides the following coverage levels:
Days 1 to 20: Medicare can cover the entire cost of your care.
Days 21 to 100: Medicare can cover the majority of the cost. However, there is a daily copayment to be paid out-of-pocket.
Over 100 days: Medicare does not cover these costs. At this point, all costs are out of pocket or require additional insurance.
What Type Of Medicare Coverage Pays These Costs?
While you are in the hospital as an inpatient, Medicare Part A can cover the costs you incur. Once you are in a skilled nursing home, Medicare Part B can begin to cover your costs. That applies only if you are within the benefits period that makes you eligible for coverage.
If you have Medicare Part C, also called a Medicare Advantage Plan, you may have the same coverage as Original Medicare (parts A and B). Medicare Part C may offer additional benefits to you. These benefits can change from one plan and provider to the next. It’s important to contact your plan provider to gather more information about coverage within that policy.
While you are in a skilled nursing facility, additional conditions may develop. Medicare can cover those additional conditions in most cases. That may include issues such as infections or complications that arise from rehab services. This coverage applies to any type of service that would be covered if you were not in a treatment center.
What Is Covered In A Skilled Nursing Facility?
Though your plan may be different, Medicare can cover some specific services in a skilled nursing facility, including:
A semi-private room and your meals
Medical supplies and medications
Necessary transportation that is not provided by the facility, such as to doctor’s appointments
Therapy, if needed, including speech, physical and occupational therapy
What Is Not Covered While In A Facility?
The skilled nursing home may offer services that are not covered under your policy. For these services, you may need to pay out of pocket. These may include:
Additional medical charges not provided by the facility
Private duty nurses and nursing sessions
Personal care items
Additional services not typically covered by Medicare, but these may be requested by a doctor and approved
Keep in mind that you can leave a skilled nursing facility and re-enter within the same 30 days, and your benefit period will not restart.