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5 Things to Know about Medicare and Your Skilled Nursing Facility Stay

A stay in a skilled nursing facility can come very unexpectedly. An injury or illness more times than not will happen abruptly and could require a stay at a skilled nursing facility. While you can never fully prepare for a health event, it is important to at least understand the basics as it relates to Medicare and post-hospitalization care. This article will outline 5 things to know about Medicare and your skilled nursing facility stay.

5 Things to Know:

  1. Qualifying stay in a hospital- In order for Medicare to pay for a SNF stay, you must have a qualifying stay of at least three days as an inpatient in a hospital. It makes sense that a stay of three days or longer would likely require post-hospitalization care. If you do not a qualifying stay in the hospital Medicare will not pay for your SNF stay.
  2. Skilled Nursing Facility Benefit Period- A benefit period as defined by Medicare is 100 days. Skilled nursing and rehabilitation services can be provided while meeting the Medicare Guidelines and you may be eligible for a new benefit period after 60 days of no hospital visits or SNF stay.
  3. Out of Pocket costs- If you have Medicare Part A, you will have no out of pocket cost for the first 20 days of SNF stay. Days 21-100 of your stay will be covered partially by Medicare, and you will be responsible for a daily co-payment of approximately $170.00 if you don’t have supplemental insurance. After 100 days, the cost is fully your responsibility.
  4. Leaving and Returning- If you leave a SNF before your 100 days is up, you have up to 30 days to return without there being another 3-day hospital stay requirement. This is important to know just in case you went home a bit before you were ready.
  5. Medicare Requirements- Medicare will cover your SNF stay if it is determined that the care is needed to improve your condition, maintain your daily functioning, or prevent your health from declining.

Knowing the basics:

Most people don’t know the basics of Medicare and how it is applied to skilled nursing facility stays until it is thrust upon them. Hospital discharge planners will help navigate the process with you, but that does not replace the importance of knowing some of the basics yourself.