Medicare will pay for skilled nursing care in a skilled nursing facility if a senior has a qualifying hospital stay and the patient needs the services of professional personnel. A qualifying hospital stay is one where the senior was admitted as an inpatient to the hospital for 3 consecutive days or more. Make sure that the senior isn’t admitted for “observation” only and was actually admitted to the hospital as an inpatient. For a period of time in the skilled nursing facility, Medicare will cover a semi-private room, meals, skilled nursing care, medical social services, medications, medical supplies and equipment and other services such as physical therapy, occupational therapy, or speech-language pathology if those services are needed to meet the patient’s health goal. Medicare will pay the full cost of the skilled nursing facility for only the first 20 days. Medicare will pay all but the daily coinsurance for days 21-100 and the patient would need to cover up to $157.50 per day for the care. Medicare will not pay for anything beyond 100 days in the benefit period. It is important to know a senior’s rights to care. Medicare will continue to cover the skilled nursing care if the care is necessary to help improve a senior’s condition or to maintain their condition and prevent or delay it from getting worse. The patient does not necessarily have to keep making improvements for Medicare to continue coverage. If the care will keep the patient from slipping, the senior has Medicare coverage for the first 100 days in the benefit period.
Written by Heather W. Winter, Esquire