What does Medicare Cover for Skilled Nursing Care?

The role of skilled nursing facilities in the health care environment continues to change with our senior population. Over the past decade, the nursing home or skilled environment was purely a residential setting where the elderly population resided. However, the health care environment has now transformed the nursing home into a post acute setting where Medicare beneficiaries can receive skilled and rehabilitative services prior to going home. If you or a loved one is in the hospital and in need of post acute care, it is important to know what your Medicare plan will cover.

Generally, Medicare beneficiaries can qualify for a Medicare skilled facility within thirty days of a hospitalization stay lasting at least three days, and must be admitted to the nursing home because of a condition related to that hospitalization. Often, after a minimum three day stay in the hospital, the physician will recommend an extended stay at a skilled nursing facility.

What does Medicare cover?

Medicare Part A is hospital insurance that covers skilled nursing care and rehabilitative services in a Medicare certified nursing facility. Medicare offers full coverage for the first 20 days and partial coverage for days 21-100. On the partial days (21-100) the coverage will require a coinsurance fee. This coinsurance amount may be covered by a supplemental insurance policy. The skilled nursing facility will be able to tell you what this coverage will be at admission.
Medicare Part A covers: nursing care, physical therapy, occupational therapy, speech therapy, respiratory therapy, room, meals, therapeutic diets, laboratory, X-ray, EKG, oxygen, medical supplies, pharmaceuticals, and intravenous therapy.

How do you qualify for the Medicare Benefit for Post Acute Care?

• Have a three night inpatient hospital stay.
• Be admitted to a Medicare certified bed within 30 days of the last Medicare covered day in a hospital or Medicare certified facility.
• Must be in a Medicare Certified post acute setting

To learn additional information about the basics of post acute care for skilled nursing and rehabilitation services, visit: http://www.medicare.gov


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