How Does Medicare Cover Skilled Nursing?

Medicare Part A, or hospital coverage, does cover skilled nursing care, under certain conditions, for a limited period of time. However, coverage limits can be confusing, and specific requirements need to be met. Read on to learn more about Medicare coverage, skilled nursing care and other options available. 

Skilled Nursing Care Medicare Requirements

In short, Medicare Part A covers the cost of a skilled nursing facility for conditions that begin with a hospital stay and require ongoing care after discharge. Here are the current requirements.

  • • You have Medicare Part A and days left in your benefit period to use.
  • • You have a qualifying hospital stay, during which you are considered an inpatient, that lasts a minimum of three days. 
  • • Your doctor believes you need skilled daily care given by, or under the supervision of, skilled nursing/therapy staff.
  • • These skilled nursing care services are received at a facility certified by Medicare.
  • • The services are needed for a medical condition that’s either: 
    • • A hospital-related medical condition treated during your hospital stay, even if it wasn’t the reason you were originally admitted to the hospital. 
    • • A condition that started while you were getting care in a skilled nursing facility for a hospital-related medical condition (for example, an infection after surgery). 

Skilled Nursing Care Costs in Original Medicare

  • Days 1 to 20: $0 for each benefit period .  
  • Days 21 to 100: $185.50 co-insurance per day of each benefit period.
  • Days 101 and on: All costs.

However, even in the first 20 days, there are some exceptions to what is covered by Medicare and not.

Services Covered by Medicare Part A

  • • Semi-private room
  • • Meals
  • • Skilled nursing care
  • • Physical therapy, if needed
  • • Occupational therapy, if needed
  • • Speech-language pathology services, if needed
  • • Medical social services
  • • Medications
  • • Medical supplies and equipment used in the facility
  • • Ambulance transportation (when other transportation options endanger your health) for medical services not available at the skilled nursing facility
  • • Dietary counseling
  • • Swing bed services

Other Coverage Options

While Medicare generally does not cover long-term care in a skilled nursing facility, there are other options. Long-term care insurance can help pay for many types of long-term care, including both skilled and non-skilled care, for periods of one year or more. This can be provided in a nursing home, an assisted living facility or in your own home. Short-term convalescent care plans pay for care in a nursing home, an assisted living facility or in the comfort of your own home for a period of less than one year. These plans vary widely, so contact your Des Moines insurance agent to find a plan that is right for you. 

To learn more about Medicare coverage and long-term care insurance, reach out to Crumes Insurance today. 

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