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Caring Senior Service of Stroudsburg

Caring Senior Service of Stroudsburg Blog

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Medicare and the Skilled Nursing Facility; Who Pays?

Posted by Ruby Cemental on Sep 12, 2017 5:30:00 PM

Rehab_seniors-LR.jpgLong-term health conditions can be stressful for the entire family. Besides the concern for the health and welfare of your loved one, there may also be concern over the high cost of quality care. That concern is magnified when your senior's care must continue after hospitalization. You or your loved one may qualify to have the cost of their hospital and skilled nursing facility covered by Medicare under certain conditions.

Medicare Part A (Hospitalization Coverage)

If your loved one is covered by Medicare Part A, their stay at a skilled nursing facility might be covered for a limited time.  Your senior may need to be in a semi- private room. Medicare will cover the cost of meals, medications, physical therapy, ambulance transportation dietary counseling, supplies, and equipment if additional considerations are met.

      Swing Bed Coverage

  • Medicare would cover the charges in a facility that offers both hospital and skilled nursing (SNF)   care. The same coverage would apply as if the patient had been transferred to another facility. Not all hospitals offer both types of service. 

Days Remaining in the Benefit Period

The benefit period starts the day of hospital admission and ends when there has not been inpatient care after 60 days. When a new benefit period begins, the patient is again required to be hospitalized and pay the inpatient hospital deductible amount.  A patient can qualify for a new benefit period without restriction. There are no limits.

Minimum Three-Day Hospital Stay

Hospitalization as an outpatient or for observation will not satisfy the terms. Inpatient status starts when a doctor signs a form to admit a patient.  For a qualifying hospital stay, admission to a skilled nursing facility must follow the hospital stay of 3 days and be initiated within 30 days of discharge.  The services need to be related to that hospital stay. If skilled nursing facility care is needed after the 30 day period, a new hospital stay is again necessary for Medicare to cover the costs.

The day of discharge does not count towards the hospitalization requirement

Rehabilitation Services

It must be determined by a doctor that a patient is being admitted to the skilled care facility to regain a function that was lost because of illness or injury or disability. This means physical or occupational therapy, speech or language pathology or psychiatric rehabilitation is necessary to regain skills. A stroke would qualify, but a hip replacement may not.

There May Be a Deductible

Medicare Part A requires a deductible to be fulfilled under original Medicare and the Medicare prescription plan before Medicare deems the stay eligible for coverage.

There May be a Co-insurance Charge

After the requirement for the detectable is met, there will be a  co-insurance (or co-deductable) charge on the remaining balance. The charge is typically 20%

There Will Still be Co-pays

During hospitalization, regular co-pay amounts still apply for prescription coverage and doctor visits. These are typically a set dollar amount rather than a percentage of the cost.

Charges are covered for the first twenty days a person is in the care of a skilled nursing facility. Then there are out-of-pocket charges.

  • Days 1-20 - pay nothing
  • Days 21-100 - Pay co-pays and pay co-insure (20%)
  • Day 101+ - Medicare covers $0

Medicare coverage can be a confusing issue. It's one more worry on your list when there is so much more to be done.

At Caring Senior Service, our expert staff is comprised of extremely knowledgeable, friendly, and trusted professionals who take pride in helping your loved one manage their daily activities. Contact us today to learn more!

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Topics: Medicare