Medicare & Skilled Nursing Facilities
If you develop a medical condition that requires daily skilled care, whether it is an injury or an illness, Medicare Part A may cover part or all of your expenses. The restrictions and guidelines that apply to the coverage are dependent on variables like the length of your stay in a Skilled Nursing Facility (SNF) and the type of nursing care you receive while there.
A stay in an SNF may be required after an illness, an injury, or certain surgeries. When a patient requires daily assistance from a skilled nurse or other health professional such as a physical therapist, they may be transferred to an SNF. In order for the cost of the stay to be covered by Medicare Part A, there are several requirements that must be met.
First, the patient must have a qualifying hospital stay which refers to an inpatient hospital stay of three days or more. During this stay, their doctor must certify that their medical condition requires daily skilled nursing care or therapy under the supervision of a skilled healthcare professional.
This care can include daily rehabilitation as directed by a physical therapist or treatment administered by a skilled nurse, such as daily injections or medication supervision. The medically necessary care can take place in a hospital’s extended care ward or in a completely separate facility.
Under Medicare Part A, generally the following services will be covered when provided by a Skilled Nursing Facility:
- Semi-private room and meals
- Skilled nursing care
- Skilled care from a rehabilitation specialist
- Medical social services
- Medical supplies and equipment used in the facility
These services must be administered in a Skilled Nursing Facility approved by Medicare, and the services must be required to treat a medical condition that was either originally treated during your qualifying hospital stay or developed during that stay.
If your stay in an SNF meets all of the Medicare guidelines, your SNF costs and fees will be completely covered at no cost to you for a visit of up to 20 days. Days 21 to 100 will incur a co-pay of $152 per day. After Day 101, all costs will be the responsibility of the patient. For more information on out-of-pocket costs for skilled nursing facility visits, see HealthPocket’s page on Medicare out-of-pocket costs.
If you stop getting skilled care in the SNF or leave the SNF entirely, your SNF coverage may be affected depending on how long your break lasts. Furthermore, if you refuse your daily therapy or skilled care you may lose your Medicare SNF coverage.
However, if you have a condition that prevents you from getting care such as catching the flu, you may be able to get temporary Medicare coverage.
There are many variables to consider when staying in a Skilled Nursing Facility. Make sure to communicate clearly and regularly with both your doctor and Medicare so that there are no surprises when the bill for your visit arrives.