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How Medicare Covers Skilled Nursing

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This month we welcome another post from our guest writer, Danielle Kunkle. Danielle is an expert in making Medicare easy. She runs Boomer Benefits, an award-winning insurance agency specializing in providing insurance for Baby Boomers. Danielle also hosts a free webinar packed with useful, digestible information about Medicare for absolute beginners. Here she joins us to share her insight into Medicare Savings Programs.

While Medicare doesn’t cover long-term care, it does provide for short-term care in a skilled nursing facility (SNF). Skilled nursing is care that is provided in a nursing facility that has the proper staff and equipment to provide rehabilitative services.

By Medicare’s definition, it is short-term care that is designed to help you recover and get back to caring for yourself on your own.

Medicare itself is made up of different parts. Each part, Medicare A, B, C, and D covers different aspects of costs related to health care. Skilled nursing care falls under Medicare A.

Let’s look at what Part A covers, how it pays for skilled nursing care and what the requirements are to qualify for coverage.

Understanding Medicare Part A

Medicare Part A is the hospital insurance component of your Medicare coverage. In addition to skilled nursing care, it provides for hospital inpatient care, blood transfusions, some home health care delivered during an inpatient stay and hospice care.

If you or your spouse have worked and paid payroll taxes into Medicare for at least ten years, you won’t have to pay a premium for Part A. However, you do have to pay a deductible for Part A services when you access this care. In 2018, that deductible is $1340.

In addition to skilled nursing care, [Medicaid] provides for hospital inpatient care, blood transfusions, some home health care delivered during an inpatient stay and hospice care.

What is Skilled Nursing and When Would I Need It?

Skilled nursing covered under Medicare is for short-term rehabilitation. You may never need to use this benefit, but it is there when you do need intensive treatment by skilled nurses or rehab professionals. Examples of skilled nursing facility services might include post-operative wound care, physical therapy, speech-language therapy, nutrition counseling, social services, medical equipment and care by registered nurses.

Occupational therapy, which helps a patient become independent again, is also covered.

An inpatient stay in a skilled nursing facility is common after major surgeries or a health event which impairs your independence, such as a stroke. Your care in an SNF is designed to get you back on your feet and return you to caring for yourself at home.

Medicare covers up to 100 days in an SNF. The first 20 days are completely covered by Medicare. Days 21-100 require a copayment from you.

What are the Requirements for Skilled Nursing Coverage?

In order for Medicare to cover skilled nursing services, you must be enrolled in Part A and have a three (3) day stay in the hospital first. You may enter the SNF within 30 days of leaving the hospital. 

In addition to the hospital stay requirement, your physician must order services that can only be provided at a SNF as an inpatient. The services you get during a skilled nursing stay are considered daily even if they aren’t available every day.

Medicare covers up to 100 .days in an SNF. The first 20 days are completely covered by Medicare. Days 21-100 require a copayment from you. In 2018, this copayment is $167.50 per day. After 100 days, the cost for SNF care is your responsibility. However, this benefit resets after you’ve been out of the facility for 60 days.

For example, if you spend 30 days in a SNF and then need to go in six months later, you must have a new inpatient stay and your doctor must again order the skilled nursing care. The two stays are in separate benefit periods separated by more than 60 days during which you were not in inpatient care.

It’s important to also mention here that Medicare does not cover long-term care. If you need care that extends beyond 100 days, then you will be responsible for paying the costs of any long-term care privately, such as that delivered in a nursing home environment.

There is insurance coverage that you can purchase while you are still healthy that is designed to help you pay for any long-term care needs in the future. Some people may also qualify for Medicaid assistance with paying for long-term care.

Covering your Cost-Sharing for SNF Stays

Since you are responsible for a daily copay starting on Day 21 of an inpatient SNF stay, you will likely want supplemental coverage to help you pay for this expense. Medicare supplements are available that will pay your daily SNF coinsurance.

This type of plan is also known as a Medicare supplement insurance plan. It helps cover the costs that Medicare doesn’t cover such as deductibles, coinsurance, and copays. In order to obtain Medicare supplement insurance, you must first have both Medicare A and B.

While there are ten standardized Medicare supplements available in most states, the most popular plans are Medicare Supplements Plan F, Plan G and Plan N. All three of these plans include SNF coinsurance.

A Medicare supplement insurance plan requires a monthly premium to be paid just like that for Medicare Part B. A Medicare insurance broker can help you find plans in your area that are competitively priced.

Understanding how your Medicare A coverage works in the event you need skilled nursing services is important.

Do you have more questions about understanding how Medicare’s coverage of skilled nursing works? Don’t hesitate to contact us for help.

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