Skilled nursing care is covered under Medicare Part A under certain conditions within a limited time frame. You must have a qualifying 3-day inpatient hospital stay, meaning you are formally admitted, to be covered in a skilled nursing facility. The skilled nursing facility needs to be certified by Medicare. The skilled nursing benefit period as covered by Medicare is 100 days. For days 1-20, Medicare pays all costs. For days 21-100, you are due a $157.50 coinsurance per day. You are responsible for all costs on days 101 and beyond.
If you have a break in skilled nursing care that lasts more than 30 days, Medicare requires a new 3-day hospital stay to qualify for additional skilled nursing care. If your break in care lasts for at least 60 days in a row, your current benefit period ends and your skilled nursing facility benefits are renewed – your maximum coverage available would replenish to 100 days. A benefit period begins the day you are admitted as an inpatient and ends when you have gone without skilled nursing care for 60 consecutive days. There is no limit to the number of benefit periods you are allowed in a lifetime. Skilled nursing facilities with Medicare include a semi-private room, meals, skilled nursing, medications, medical supplies, equipment, physical and occupational therapy, ambulance transportation, and dietary counseling. Please note that if your Doctor recommends services that Medicare does not cover or more often than Medicare covers, you may be responsible for some or all of the costs. To learn more about skilled nursing care visit: www.medicare.gov/snf.