Medicare Skilled Nursing Facility (SNF) care is a type of short-term care that is covered by both Medicare Part A and Part B for patients who require daily skilled nursing care or skilled rehabilitation services, such as physical therapy, occupational therapy, or speech therapy, following a qualifying hospital stay.
While SNF care is typically provided in a Medicare-certified nursing facility and is designed to help patients recover and regain their ability to function independently, it is instructive to note that the coverage plans and pay for nursing homes differ.
In this piece, we shall examine the criteria patients under Medicare Part A and Medicare Advantage Plans must fulfill before qualifying for SNF as well as areas of coverage.
Key Criteria for Skilled Nursing Facility (SNF) Care
Whether you are on original medicare (Part A) or Medicare Advantage Plans, you must satisfy the following criteria in order to qualify for skilled nursing facility (SNF) care. These criteria include:
- Have a qualifying hospital stay: you must have been admitted to the hospital as an inpatient for at least three consecutive days (not including the day of discharge). The admission must have been for a medically necessary reason.
- Need skilled care: you must need daily skilled nursing care or skilled rehabilitation services, such as physical therapy, occupational therapy, or speech therapy. This care would be provided by or under the supervision of a skilled healthcare professional, such as a registered nurse or therapist.
- Available Medicare-certified facility: you must receive SNF care in a Medicare-certified facility that meets certain quality standards and participates in the Medicare program.
- Need care related to the hospital stay: you must need SNF care for a condition that is related to the hospital stay. This means that not every health condition can be considered for SNF.
If you are not qualified for SNF, you may still be eligible for other types of care such as home health care or hospice care, which may be covered under Medicare Part A.
What Are Covered Under Nursing Home?
It is noteworthy that Medicare Part A will cover up to 100 days of SNF care, with the first 20 days covered at 100%, and the remaining 80 days subject to a daily coinsurance payment. However, Medicare only covers the cost of the skilled nursing care received in the SNF, not room and board.
If an individual requires long-term care in a nursing home beyond the 100 days covered by Medicare, they will need to pay for it themselves or rely on other sources of coverage such as Medicaid, private long-term care insurance, or personal savings.
Like Original Medicare, Medicare Advantage plans cover up to 100 days of SNF care following a qualifying hospital stay, as long as the care is medically necessary and provided in a Medicare-certified SNF.
The first 20 days of SNF care are covered at 100%, while the remaining 80 days require a daily coinsurance payment. Additionally, Medicare Advantage plans may require prior authorization before covering SNF care.
It should be noted that not all Medicare Advantage plans offer coverage for nursing home care. The specific coverage and cost-sharing requirements may vary depending on the plan. It’s essential to review the benefits and limitations of a Medicare Advantage plan before enrolling to ensure that it meets your healthcare needs.
Skilled Nursing Facility (SNF) – Is Medicare Part A Better Off?
It should be clearly stated that when it comes to coverage for skilled nursing facility (SNF) care, both Medicare Part A and Part B offer this service.
Medicare Advantage plans also cover skilled nursing facility (SNF) care with varying specific coverage and cost-sharing requirements.
However, If you have a chronic condition or require ongoing medical care after a hospital stay, Medicare Part A may be more beneficial as it provides coverage for SNF care.
Getting Started with a Medicare SNF Service?
By getting started today, you will harness the full benefits inherent in a Skilled Nursing Facility (SNF) service. The MedicareOnVideo series has simplified the A-Z processes involved.
You can also follow the step-by-step processes as practically explained in the Medicare ebook containing relevant content, links, and videos on Medicare areas of coverage.
The Bottom Line
Whether you are on original Medicare or Medicare advantage Plans, enrolling in the package that suits you is key as it will determine the skilled nursing care services you enjoy during a health crisis. .
In order to prepare ahead of time, watch Medicare Video titled “Does Medicare Pay for Nursing Home” for authoritative guidance or call us via 1-877-855-3484.
Seniors’ health condition remains our concern. Hence, we are always at your beck and call.