Medicare Benefits for Skilled Nursing Facility Care

After you have been hospitalized, the recommendation may be that you receive further medical care at a Skilled Nursing Facility rather than being discharged back home. The advantage with this scenario is that you are in a facility with medical professionals. Some important questions to ask your care professionals are:

What makes me eligible for Medicare to pay for
my stay in a Skilled Nursing Facility (SNF)?

There are several criteria that must be met before Medicare will pay:

  • You need to have Medicare Part A and have days left in your benefit period (see next question for more on how long Medicare will cover).
  • A three day qualifying hospital stay and must enter the SNF within 30 days of being discharged from the hospital.
  • Your doctor has decided that you need skilled care (either skilled nursing care or restorative therapy) after this hospitalization

For how long will Medicare pay for me
to be in a Skilled Nursing facility (SNF)?

You can have up to 100 days of coverage in a benefit period, provided you are receiving skilled care for the entire time. Usually skilled care ends before the 100th day because people either recuperate or they “plateau” (i.e. stop making progress).

  • A benefit period begins the day you start using either the hospital or SNF benefits under Part A of Medicare.
  • A benefit period is renewed only after you have not needed any skilled care (either in the hospital or a SNF) for 60 consecutive days.

What cost am I responsible for during
my stay in a Skilled Nursing Facility (SNF)?

Your payment responsibility is as follows:

  • Medicare will pay for 100% of the cost of care from the 1st day to the 20th day.
  • There is a co-pay of $164.50/day (2017 rate) from the 21st day to the 100th day.
  • If you have secondary insurance, it may cover part or all of this co-pay.
  • You are also responsible for paying any ancillary charges that may be applied to your stay, such as for phone or laundry fees.

In addition to the services Skilled Nursing Facilities provide, many people feel more comfortable having a caregiver devoted to just them and their personal care needs. Private duty home care agencies often coordinate with both the family and facility when sending a caregiver who can assist you in a multitude of ways. Caregivers can assist with getting to and from the bathroom in a timely and safe manner; assistance during meals, providing support though companionship, etc. Caregivers can also transition with you when you return home for as long as you would require – a few days until you get settled or for longer.

(adapted from www.medicare.org)

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