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Sacramento CA Estate Planning Blog

Thursday, October 30, 2014

Medicare and Skilled Nursing Care - When Will Medicare Pay?

Skilled nursing facilities (SNF), commonly called nursing homes or rehab centers, provide temporary and long-term care for those who need medical care while recuperating, or for those who need assistance with daily living on a permanent basis.

 Medicare will cover SNF care only if all of the following are true:

1.  You have Medicare Part A (Hospital Insurance) and have days left in your benefit period available to use.

2.  You have a "qualifying hospital stay."  This means an inpatient hospital stay of at least 3 consecutive days, starting with the day the hospital admits you as an inpatient, but not including the day you leave the hospital  You must enter the SNF within a short time of leaving a hospital, typically 30 days.  

3.  Your doctor has ordered the services you need for SNF care, which require the skills of professional personnel such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech- language pathologists or audiologists, and are furnished by, or under the supervision of, these skilled personnel.

4.  You require the skilled care on a daily basis and the services must be ones that, as a practical matter, can only be provided in a SNF on an inpatient basis.  If you are in a SNF for skilled rehabilitation services only, your care is considered daily care even if the therapy services are offered just 5-6 days a week.

5.  You need these skilled services for a medical condition that (a) was treated during a qualifying 3-day hospital stay; or (b) started whole you were getting SNF care for a medical condition that was treated during a hospital stay.  For example, if you are in a SNF because you broke your hip and then have a stroke, Medicare may cover rehabilitation services for the stroke, even if you no longer need rehab for your hip.

6.  The skilled services must be reasonable and necessary for the diagnosis or treatment of your condition.

7.  You get these skilled services in a SNF that is certified by Medicare.

Medicare will pay ​up to​ 100 days of SNF coverage in a benefit period.  Once you use those 100 days, your coverage is ended.  However, if you have ​another​ 3-day qualifying hospital stay and meet the Medicare requirements listed above, you can get up to another 100 days of SNF benefits.  





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