To qualify for Medicare coverage for care in a skilled nursing facility, a doctor must certify that you need daily skilled medical care, and you must have Medicare Part A. You must also have hospital days left in your benefit period.
A Medicare benefit period begins the day you are admitted to a hospital, and ends when you have been out of a hospital or a skilled nursing facility for 60 consecutive days, including the day you are discharged. The benefit period also ends if you are in a skilled nursing facility, and have not received skilled nursing care for 60 days in a row. When a benefit period has ended, a new benefit period begins, and hospital and skilled nursing facility benefits are renewed. There is no limit to the number of benefit periods allowed.
In addition to the above Medicare requirements, you must have had a hospital stay of three days or more (not including the day you left the hospital), and you must enter a skilled nursing facility within 30 days of leaving the hospital.
If you leave a skilled nursing facility, you may re-enter within 30 days without another qualifying hospital stay. You must also need the services for a medical condition that was treated during a qualifying three-day hospital stay, or started while you were receiving Medicare-covered skilled nursing facility care.
Care in a skilled nursing facility is covered by Medicare Part A, and will cost you nothing for the first 20 days. From the 21st day through the 100th day, it will cost you $128 a day, but Medicare pays nothing for the 101st day or beyond.
If you are covered by a Medicare Advantage plan, or Medicare Supplement Insurance, you may have more coverage. At MediGap Advisors, our experts can answer your questions about Medicare Advantage, and Medigap Insurance, and help you select the plan that is right for you at the best price we can find. You can get started with our Medigap “How To” Guide, or call us at 866-323-1441 to schedule a no-cost consultation at a time that’s convenient for you.