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Medicare Coverage - Skilled Nursing Facility Care

Medicare provides insurance coverage for care provided in skilled nursing facilities (SNFs), typically nursing homes and acute hospitals with skilled nursing beds.

How Is Eligibility Determined?

Medicare coverage for SNF care requires both a prior hospital stay and a need for the requisite level of care.

Prior Covered Hospitalization

A patient desiring coverage for skilled nursing care must have been discharged from at least a three-day stay of covered hospitalization in a hospital that participates in Medicare or is Medicare-qualified. The day of discharge is not counted in determining whether the stay meets this three-day requirement.

Type And Timing of Care Needed

The patient must also need daily skilled nursing care upon discharge from the hospital. He or she must be admitted to the SNF, and the care must begin no more than 30 days after discharge from the hospital.

What Services Are Covered?

Some of the covered SNF services are similar to those covered under Medicare's hospitalization coverage: bed and board, medical supplies and appliances, prescriptions, and transport. Additionally, nursing care is covered, along with care provided under a registered nurse's supervision, as are physical, occupational, and speech therapy.

Medicare only covers services on the days that they are actually provided. A physician must order services for them to be covered, and they must be provided by either professional personnel, such as nurses and therapists, or under the supervision of these personnel. Services are not covered unless they can, practically speaking, only be provided by either a hospital or an SNF.

There need not be a possibility of recovery or improvement for Medicare to provide SNF services. Instead, services are considered "needed" if intended to preserve the status quo.

How Is Coverage Provided?

Medicare pays for all covered SNF services during the first 20 days after a covered hospitalization stay. From the 21st through the 100th day, patients must pay a daily coinsurance amount; Medicare then pays for the remainder of the covered services. Generally, coverage ends after 100 days. However, if a patient is discharged and readmitted to the SNF within that 100-day period, Medicare will pay until the 100-day period expires. Additionally, if a patient is discharged from the SNF for 60 days and the benefit period has expired, the patient must reestablish eligibility with another covered hospitalization.

Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.