Does Medicare Cover Skilled Nursing Facilities?:
- Only a small number of skilled nursing facilities are covered by Medicare.
- For skilled nursing facility coverage, a hospital stay is necessary.
- Medical services are covered for the first 100 days following a hospital stay.
- After the first Medicare coverage period has been completed, copayments are necessary.
If you think Medicare will fund skilled nursing facility snf, you’re not insane. Medicare coverage constraints, on the other hand, might be baffling, and you must meet certain requirements ahead to your stay.
Under a nutshell, in some cases, Medicare will fund short-term stays in skilled nursing facility. If you need long-term or continuous care in a skilled nursing facility, you will have to pay for it yourself or via other programmes.
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Does Medicare cover skilled nursing facilities?
To put it bluntly, yes it does cover skilled nursing facility snf. Medicare is a government-funded healthcare program for those aged 65 and over, as well as anyone with specific medical conditions. Medicare is divided into several distinct plans, each of which offers various types of coverage at different rates.
Medicare Part A
Part A of Medicare covers inpatient hospitalizations. “Original Medicare” refers to Parts A and B of the program. The Medicare Part A monthly charge is usually free if you paid into the Medicare system through taxes throughout your working years.
You must enroll in Medicare Part A when you reach the age of 65 or if you have certain medical issues. Medicare Part A covers your stay in a skilled nursing facility, rehab center, hospice care, and some home medicare interactive services.
Medicare Part B
For Medicare Part B, you’ll have to pay a monthly premium that is based on your income. The majority of customers will pay $144.60 per month in 2020. Part B covers the bulk of outpatient medical treatments.
Medicare Part C
Medicare Part C, or Medicare Advantage, plans are sold by private insurance companies. These plans contain all of the benefits of standard Medicare, as well as supplemental coverage for prescription medications, vision, and dental care. Depending on your requirements and financial situation, you can choose from a number of Medicare Advantage plans.
Medicare Part D and Medigap
Also accessible is Medicare Part D, which covers prescription medicines. Private supplemental insurance, often known as Medigap policies, can help pay for treatments that aren’t covered by Medicare’s other programs.
When will Medicare pay for skilled nursing care?
Medicare Part A covers the cost of a skilled nursing facility for issues that arise during a hospital stay and require ongoing care after discharge. While this looks to be a simple procedure, there are a few prerequisites to meet in skilled nursing facility coverage, including:
- A stay in the hospital is required due to your illness or injuries. These events might include a fall, a stroke, a heart attack, pneumonia, worsening heart failure or chronic obstructive pulmonary disease (COPD), or surgery.
- There is a need for a minimum stay. An initial hospital stay of at least three days is required.
- While in the hospital, you must be treated as an inpatient. A hospital stay for observation is not considered a valid hospital stay. The 3-day guideline does not apply to time spent in the ER, in observation, or on the day of discharge.
- Once you’ve been released, your doctor will need to schedule follow-up therapy. This means that the illness for which you were admitted to the hospital needs 24-hour care in a skilled nursing facility.
- You’re covered for any illnesses you incur while in a skilled nursing facility. This might be a concern if you contract an infection while receiving rehab services after joint replacement surgery.
Why would I need skilled nursing care?
After you’ve been released from the hospital due to an accident or a new ailment, your doctor will determine if you need to continue treatment. This decision is based on your ability to care for yourself at home if you have help, and the sort of care needed for your medical condition.
If you need specific therapies or treatments to recuperate, or if your condition demands the support of a professional or trained person, your doctor may propose skilled nursing care.
In 2019, the following were the most common diseases that need skilled nursing care:
- septicemia
- joint replacement
- heart failure
- shock
- hip and femur procedures, aside from the joint replacement
- kidney and urinary tract infections
- COPD
- renal failure
- pneumonia
How much will Medicare cover?
Medicare coverage for skilled nursing facilities is broken down into benefit periods. A benefit period begins the day you are admitted as an inpatient to a hospital or skilled nursing facility care.
Throughout the benefit term, various amounts are paid. The benefit period ends after 60 days without the need for a hospital or skilled nursing facility care. A fresh benefit period will begin if you return to the hospital after the 60-day period has passed.
The following are the charges that apply during the benefit period:
- Days 1 through 20: Medicare will cover the whole cost of your care for the first 20 days. There will be no cost to you.
- Medicare will cover the bulk of the expenditures from days 21 to 100, but you will be liable for a daily copayment. In 2020, the copayment will be $176 per day.
- Medicare does not cover the expenses of skilled nursing facility care after day 100. At this point, you are responsible for the whole cost of care.
There are various exclusions to what is covered even within the first 20 days of staying in a skilled nursing facility.
Items and services covered by Medicare:
- A semi-private room will suffice unless a separate room is necessary for medical reasons.
- Medical services are not available at a skilled nursing facility.
- Medications and medical equipment.
- Meals and dietary recommendations.
- Physical therapy, occupational therapy, speech therapy, and social aid will be offered as necessary.
Items and services NOT covered by Medicare:
- Additional phone or television costs are not covered by the facility.
- It is possible to hire a private duty nurse.
- Personal items include razors, toothpaste, and other items for personal hygiene.
There are a few more Medicare coverage rules you should be aware of, including:
- Your doctor may seek additional services not covered by Medicare on your behalf.
- You don’t have to start a new benefit term if you need to return to the skilled nursing facility within 30 days.
- Medicare does not cover long-term care. Long-term care comprises custodial care, which is when you need assistance with daily duties but don’t need a medical specialist, and assisted living, which is a residential environment that includes medical treatment on occasion.
What is a skilled nursing facility?
Skilled care refers to nursing or therapeutic services that must be performed or monitored by a professional. Other procedures such as wound treatment, physical therapy, IV medication, and others may be included.
Skilled nursing facilities can be found within hospital units, although they are in the minority. The bulk of skilled nursing homes are private, for-profit businesses. Short-term medical treatment, rehabilitation, and long-term care are all common services they provide.
TIP
Medicare offers an online tool to help you locate licenced skilled nursing facilities. Case managers and social workers can also help you get coverage for your hospital or skilled nursing facility stay.
What about inpatient rehabilitation care?
Medicare will also fund rehabilitation therapies. These services are similar to skilled nursing, but they also involve intensive rehabilitation, ongoing medical care, and a multidisciplinary team of doctors and therapists to offer coordinated care.
In a rehabilitation center, Medicare covers the same goods and services as it does in a skilled nursing facility services (shared rooms, food, prescriptions, and therapies). Exclusions remain the same (television and phone services, as well as personal hygiene supplies).
Inpatient rehabilitation may be required if brain damage demands both neurological and physical therapy. It might also be a separate type of serious injury that affects many-body systems.
Inpatient rehabilitation has a different quantity of coverage than skilled nursing. The following are the expenses of Medicare Part A for each benefit period:
- Days 1 through 60: There is a $1,364 deductible for rehabilitative therapy for the first 60 days of treatment.
- From days 61 through 90, you’ll pay $341 in daily coinsurance.
- After day 90 of each benefit period, each benefit period has a daily coinsurance of $682 per “lifetime reserve day” (these are 60 additional days of coverage that can be used only once during your lifetime).
- You’ll be responsible for all care costs once you’ve used up all of your lifetime reserve days.
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Getting help with long-term care costs
In addition to Medicare Advantage and Medigap insurance, there are a number of public and private programs that can help pay for skilled nursing costs. Listed below are a few examples:
- PACE (Program of All-inclusive Care for the Elderly) is a
- Medicare/Medicaid program that helps people with their healthcare needs in their communities.
- Medicare savings plans are programs in which your state helps you pay your Medicare premiums.
Extra Medicare assistance may be available to assist with prescription costs. - You may be able to utilize Medicaid to help pay for long-term care if you qualify.
A FEW LAST TIPS
- If you believe you may require professional nursing care following a hospital stay, speak with your doctor as soon as possible.
- During your stay, make sure you’re labeled as an inpatient rather than an observation patient.
- Request that your doctor writes any evidence that demonstrates the need for a skilled nursing facility due to your sickness or condition.
- Consider hiring a senior care manager from a reputable source to assist you in planning your care and coordinating coverage.
- Medicare will reimburse certain at-home therapies if you are able to go home and have someone to assist you.
- Before deciding on a plan, look over the various Medicare program possibilities and think about what sort of coverage you could need in the future.
- Check your state’s Medicaid or other public and private assistance programs to see whether you qualify.
The takeaway
- Medicare covers short-term care in skilled nursing or rehabilitation facilities.
- Your medical condition, the length of time you will need treatment, and any supplementary insurance plans you have to decide the amount covered.
- Medicare does not cover long-term care.
- Consider your future healthcare needs while deciding whether or not to join up Medicare and assessing your program options.
