While many medical procedures are performed on an outpatient basis, meaning the patient receives care and returns home the same day, some treatments require additional monitoring, specialized care and access to rehabilitation services. This is often the case after an extensive surgery, but it may also be the case when someone needs care after a traumatic brain injury or a similar circumstance. In these situations, hospitalization may be required, but after being discharged from a hospital, additional medical care may be administered in a skilled nursing facility.
What is a Skilled Nursing Facility?
A skilled nursing facility is a medical center that provides residential housing and medical treatment for patients who need temporary intensive care. These facilities are staffed around the clock, and patients admitted to a skilled nursing facility will reside on the premises so that they are able to receive monitoring and treatment based upon the orders issued by a medical professional involved in treatment.
For Medicare recipients, there are restrictions on the length of time of each stay in a skilled nursing facility. In most cases, Medicare benefits will cover the cost of a stay in a skilled nursing facility for up to 20 days. From day 21 through day 100, the patient will usually be charged a set amount per day. From day 101 and beyond, the patient is liable for all costs.
Does Medicare Part D Cover Me in a Skilled Nursing Facility?
Original Medicare has several parts within the program that pay for different medical care expenses. In most cases, Part A will be responsible for covering care in a skilled nursing facility. Part B covers outpatient care, and Part D covers prescription drugs that are purchased from a retail pharmacy and are self-administered. As a result, Medicare recipients will usually not have to rely on Part D at all while in a skilled nursing facility, and instead, Part A would cover the cost of care.
With this stated, Part D would be billed if for some reason Medicare administrators found that a particular drug therapy was not to be included in skilled nursing facility coverage. This would be an exception, but it is possible that it could happen. If this did occur, then billing would move on to Part D for consideration.
Choosing a Skilled Nursing Facility
While it would be nice to be able to choose any skilled nursing facility to stay at for care, Medicare recipients are only able to receive coverage at facilities that have been approved by Medicare. This means that if you opt for care at a facility not approved by Medicare, you will likely be responsible for 100% of the cost of your care, even if you have Part A coverage.
It is possible, however, to file for a waiver in certain circumstances where care can’t be administered at any other facility or when it would be dangerous for the patient to be transported to a different facility. To learn more about filing for a waiver, you should contact your Medicare benefits plan manager to discuss your options.