The odds of a multi-day hospital stay increase substantially the older we get. The odds of needing additional skilled care after that hospital stay also increase as we face more complex medical challenges. This often raises the question of whether Medicare insurance provides coverage for skilled nursing facilities. The good news is that skilled nursing facility care can be covered by Medicare. There are, however, several eligibility requirements and limitations.
To qualify for Medicare coverage for a stay at a skilled nursing facility, you must be enrolled in Medicare Part A. Your hospital visit must last for at least three days of inpatient care. A doctor must determine that you require care on a daily basis by a skilled nurse or the supervision of one.
The nursing facility you go into must have Medicare approval. The medical condition that you get treatment for must also be a condition treated during your hospital stay. You can also receive treatment for a condition you develop during your stay at a skilled nursing facility that’s related to your original condition. A post-operation infection, for example, would likely qualify.
Understanding a Qualifying Hospital Visit
Not every visit to the hospital, even one where you stay for three days, is a qualifying visit. Doctors frequently admit patients for a day of observation, rather than treatment. The day of observation doesn’t qualify as inpatient care. The three-day clock only begins when your doctor formally admits you for inpatient treatment.
Types of Covered Treatments
You can receive a wide range of possible treatments under this coverage. Some of the possible treatments or care include:
• Physical or occupational therapy
• Ambulance transportation
• Medical supplies or equipment
• Semi-private room
Other covered treatments and services include medical social services, dietary counseling, and speech-language pathology services.
Breaks in SNF Treatment
Breaks in treatment followed by re-admittance into a skilled nursing facility are common, but coverage is subject to certain rules. If you leave the SNF for less than 30 days and then return, you don’t need another qualifying hospital visit. If you leave for more than 30 days, you will need another qualifying hospital visit to be readmitted to the SNF.
Costs of a Stay in a Skilled Nursing Facility
Your Medicare insurance doesn’t provide unlimited coverage for skilled nursing facilities. The first 20 days of treatment in a given benefit period receive full coverage. For any days falling between 21 and 100 days of treatment in the facility, you’re responsible for a $170.50 co-payment per day. You’re responsible for the full cost for any days of treatment beyond 100 days. If you are enrolled in a Medicare Advantage plan, you will have at least the same Part A and Part B benefits as Original Medicare, but many include additional benefits.