How does Medicare cover Skilled Nursing?

Long Term Care?  Home Health Care?

Skilled nursing facility care

 

Medicare covers semi-private rooms, meals, skilled nursing and rehabilitative services, and other medically necessary services and supplies furnished in a skilled nursing facility after a 3-day minimum, medically necessary, inpatient hospital stay for a related illness or injury. An inpatient hospital stay begins the day the hospital formally admits you as an inpatient based on a doctor’s order and doesn’t include the day you’re discharged. You may get coverage of skilled nursing care or skilled therapy care if it’s necessary to help improve or maintain your current condition.

To qualify for skilled nursing facility care coverage, your doctor must certify that you need daily skilled care (like intravenous injections or physical therapy) which, as a practical matter, can only be provided in a skilled nursing facility if you’re an inpatient.

You pay:

• Nothing for the first 20 days of each benefit period
• Coinsurance per day for days 21–100 of each benefit period
• All costs for each day after day 100 in a benefit period

Note: Medicare doesn’t cover long-term care or custodial care.

Resources & Links

medicare.gov/-skilled-nursing-facilities

Medicare & You – See link in side panel

Pamphlet on Skilled Nursing from Medicare 

 

Home health services

You can use your home health benefits under Part A and/or Part B to pay for home health services. Medicare covers medically necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, or continued occupational therapy services. A doctor, or certain health care professionals who work with a doctor, must see you face to-face before a doctor can certify that you need home health services. A doctor must order your care, and a Medicare-certified home health agency must provide it.

Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment, and medical supplies for use at home. You must be homebound, which means:

• You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
• Leaving your home isn’t recommended because of your condition.
• You’re normally unable to leave your home because it’s a major effort.

You pay nothing for covered home health services. You pay 20% of the Medicare-approved amount, and the Part B deductible applies, for Medicare covered medical equipment. copied from Medicare & You – see brochure in side panel *

Learn more 

Skilled Nursing Official Booklet

Home Health Official Booklet

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Medicare - Skilled Nursing 
Publication # 10153

Medicare Skilled Nursing Pamphlet

 

Medicare & You - Nursing Home -

Long Term Care  Video 

Introduction

The Basics

A quick look at Medicare coverage of skilled nursing facility
(SNF) care
What’s skilled nursing facility (SNF) care?
Why would I need skilled nursing or therapy care?
How do I find and choose a skilled nursing facility (SNF)?

Medicare SNF Coverage

When will Medicare cover skilled nursing facility (SNF)
care?
How long does Medicare cover my SNF care?
Examples of Medicare skilled nursing facility (SNF) coverage
What does Medicare cover when I qualify for skilled nursing facility (SNF) care?

What You Pay

What do I pay for skilled nursing facility (SNF) care in 2015?
Ways to get help paying for skilled care and other health care costs

Your Care in a SNF

What’s an assessment?
What’s a care plan?

When Your Medicare Coverage Ends

What if I think my skilled nursing facility (SNF) coverage is ending too soon?
Plan ahead

Skilled Nursing Facility Checklist

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4 comments on “Skilled Nursing SNF & Home Health What Medicare Pays

    • Skilled Nursing Facility Benefits

      Benefits are provided for Skilled Nursing services in a Skilled Nursing unit of a Hospital or a freestanding Skilled Nursing Facility, up to the Benefit maximum as shown on the Summary of Benefits.

      The Benefit maximum is per Member per Benefit Period, except that room and board charges in excess of the facility’s established semi-private room rate are excluded.

      A “Benefit Period” begins on the date the Member is admitted into the facility for Skilled Nursing services, and ends 60 days after being discharged and Skilled Nursing services are no longer being received.

      A new Benefit Period can begin only after an existing Benefit Period ends Specimen Policy

      Summary of Benefits

      Skilled nursing facility (SNF) services Up to 100 days per member, per benefit period,

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