If someone is ready to leave a hospital stay but not quite ready to be sent home, they might be transferred to a skilled nursing facility (SNF). Skilled nursing facilities provide 24-hour medical care to patients.

Medicare Part A covers skilled nursing care, but for a limited time – today, we will go over this in more detail.

What is a skilled nursing facility?

This is a facility that provides on-site, round-the-clock medical care for post-hospital patients. Some of this care includes:

  • Administration and monitoring of medications
  • Tube feeding
  • Wound care
  • Physical therapy
  • Exercise
  • Bathing & hygiene

The skilled nursing facility is often associated with a hospital or nursing home.

Eligibility

Medicare Part A will cover a skilled nursing facility if a person has days left in their benefit period.

Rules

There are specific rules to follow when considering coverage options for an SNF. These rules apply for Medicare to cover the costs:

  • A person must have been admitted to a hospital for inpatient care for at least three consecutive days before coming to the SNF
  • An individual must enter a Medicare-certified SNF within 30 days of leaving the hospital
  • Treatment at the SNF should be for the same condition that was treated at the hospital, and care should be necessary seven days a week
  • If therapy services are required, they must be needed five days per week at least

The individual may initially be admitted to the hospital for one condition but end up with another while admitted. As long as they meet the required three-day period, the new condition should be eligible for SNF coverage if needed. Conditions such as infections that may develop at the SNF are also usually covered by Medicare.

Coverage

Some services included in an SNF stay that Medicare covers are (but are not limited to):

  • Some ambulance transportation
  • Dietary counseling
  • Meals
  • Medical social services
  • Medical supplies and equipment used in the SNF
  • Occupational therapy
  • Physical therapy
  • Prescription drugs
  • Semi-private room
  • Skilled nursing care
  • Speech-language pathology services
  • Swing bed services

Please consult with a doctor or hospital discharge planner to help find a Medicare-certified SNF that meets their needs.

Medicare 100 Day Limit

Medicare covers differently depending on the length of the SNF stay. After a 20 day stays, there is a copay, and the amount increases with the stay’s length.

Days 0-20 – $0

Days 21-100 – $176

Days 101+ – 100% of costs

Keep track of the days spent in a nursing facility to avoid any unexpected out-of-pocket costs.

Benefit Period

A person has a 60 day benefit period that applies to both hospital and SNF stays. Once a person has been discharged from the hospital or SNF for 60 days, a new admission will result in a new benefit period. This means they are eligible for another 100 days of SNF care covered by Medicare after a qualifying hospital stay.

After 100 Days

Post-100 days, Medicare may continue to cover some medically necessary skilled therapy services while the person is in an SNF, but the person will still have to pay out of pocket for the room & board costs. Some individuals can see if they qualify for at-home therapy through Medicare’s home health benefit. Also, when a patient can receive outpatient therapy safely, different coverage options will apply.

Extra Financial Help

If the person does not meet Medicare’s requirement for the SNF or the person has reached their 100-day limit, Medicaid may be able to offer help if the person is eligible.

If a person is enrolled in a Medicare Advantage plan, they should contact their insurer to see which SNF’s are in-network, as they will be more cost-effective.