What part of medicare covers skilled nursing facilities

Medicare provides coverage for care required at a skilled nursing facility (SNF). The coverage is available for a set amount of time, and rules apply.

If a person is ready to leave the hospital but still requires certain types of specialized care, they may be transferred to a skilled nursing facility.

A skilled nursing facility is a health care facility that provides in-person, 24-hour medical care.

Medicare Part A may cover skilled nursing facility care for a limited time, and this article will look at the coverage options in more detail.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

• Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
• Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
• Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

A skilled nursing facility (SNF) is a health care facility that provides on-site, 24-hour medical care. The facilities offer post-hospital nursing care, including:

• administering and monitoring prescribed medication
• tube feedings
• wound care
• physical therapy and exercise
• bathing and hygiene

Skilled nursing facilities may be affiliated with nursing homes or hospitals.

Medicare Part A may cover skilled nursing facility care if a person has days left in their benefit period to use.

Rules

There are certain rules that must be followed when considering coverage options for a SNF. For Medicare to cover costs, the following rules apply:

• A person must have been formally admitted to a hospital as an inpatient for at least three days in a row before being transferred to the SNF.
• An individual must enter a Medicare-certified SNF within 30 days of leaving the hospital.
• Treatment at the SNF should be for the same health condition that a person received treatment for at the hospital, and care should be required seven days a week.
• If therapy services are required, treatment should be needed a minimum of five days per week.

An individual may initially have to go to the hospital for one health condition, but develop another while admitted that also requires hospital treatment.

As long as a person meets the three-day qualifying period, the new condition will be eligible for coverage at an SNF, should it be required.

A health condition, such as a new infection that begins while a person is receiving care in a skilled nursing facility, is also usually covered by Medicare.

Medicare-covered services during a stay at an SNF include, but are not limited to:

• some ambulance transportation services
• dietary counseling
• meals
• medical social services
• medical supplies and equipment used in the facility
• occupational therapy (if required)
• physical therapy (if required)
• prescription drugs
• semi-private room (a room a person shares with someone else)
• skilled nursing care
• speech-language pathology services (if required)
• swing bed services

A person can talk with their doctor or hospital discharge planner to get help finding a Medicare-certified SNF that meets their needs.

Medicare pays differently, depending on how long a person is in an SNF.

After day 20, a person must pay a copayment, and the amount increases with the length of the stay.

The table below shows how copayments change. The copayment applies to each benefit period.

It may be of use to a person or caregiver to keep track of the number of days spent in a skilled nursing facility, to avoid unexpected costs.

Benefit period

A person has a benefit period of 60 days that applies to hospital and SNP stays.

Once a person has been home from the hospital or SNF for 60 days in a row, a new admission would result in a new benefit period.

This means that an individual may be eligible for another 100 days of Medicare-approved SNF care after a qualifying inpatient hospital stay.

After 100 days

After 100 days, Medicare may continue to cover medically-necessary skilled therapy services while a person is in the SNF, but they may have to pay the cost of room and board out of pocket.

Individuals can check with Medicare to see if they qualify for at-home therapy through the Medicare home health benefit.

A doctor may also advise that a person is now able to safely receive therapy as an outpatient, at which point different coverage options may apply.

If a person does not meet the requirements for the skilled nursing facility benefit, or the person has reached the 100-day limit for SNF care, Medicaid may be able to offer nursing facility services to those eligible.

If a person has a Medicare Advantage plan, they can contact their insurer to discover which SNFs are in-network, as participating facilities are usually more cost-effective.

A skilled nursing facility (SNF) is a health care facility that provides 24-hour medical care. SNFs provide post-hospital nursing care.

Medicare-approved SNF services are covered from Medicare Part A, providing a person meets the eligibility criteria.

If a person does not meet the requirements for the skilled nursing facility benefit, or the person has reached the 100-day limit for SNF care, Medicaid may be able to help pay for the care.