Dedicated Skilled Nursing Care

You have options when it comes to paying for skilled nursing care. Below is a list of all the possible payment options for a skilled nursing facility. 

Medicare

To receive Medicare services, you must use a Medicare-certified skilled nursing facility. Medicare Part A provides 100 days of coverage per benefit period. Your benefit period starts the day you begin receiving hospital or skilled nursing facility benefits.

Here’s how the coverage works:

• The first 20 days are fully covered by Medicare Part A.
• For the remaining 80 days, Medicare covers all charges except for the co-insurance amount as long as you meet the skilled level of care criteria.

Your benefit period ends if:

• You have not been in a skilled nursing facility (SNF) or hospital for at least 60 consecutive days.
• If you are still in a skilled nursing facility, you must go 60 days without receiving skilled care to renew your benefit period.

You are not limited to a certain number of benefit periods. However, to qualify for another 100-day Medicare benefit period, you must have another three-day hospital stay and continue to meet Medicare requirements.

Medicaid

Medicaid is a State and Federal program that will pay most nursing home costs for people with limited income. Since Medicaid is a State and Federal funded program, each state offers different eligibility criteria. You will only receive the benefits of Medicaid if the skilled nursing facility that you are a resident of is certified by the government.

Private Pay

Most nursing home residents pay for their nursing home stay out of their own personal accounts. Once you have depleted your funds and are becoming long-term residents of a nursing facility, the majority of people are able to receive Medicaid.

Medigap

This is private insurance that helps to fill in the gaps that Medicare parts: A and B do not cover such as deductibles, co-insurance, or skilled nursing facility services that extend beyond the Medicare benefit period. A Medigap plan will assist in paying skilled nursing care but only if the care is covered by Medicare.

Long-Term Care Insurance

All long-term care insurance policies differ when it comes to benefits and costs. You will need to contact the NAIC (National Association of Insurance Commissioners) for more detailed information regarding the different long-term care insurance policies.

When you go to a skilled nursing facility, a team of staff plans your care based on the doctor’s (the facility medical director) orders and the results of your daily assessments:

• Your doctor and the staff review your assessments and determine the necessary services and set health goals for you. A health goal could be something like being able to walk a certain distance or climb stairs.
  Your daily assessments and skilled care begin the day you arrive at the facility.

After your initial assessment, the facility will create a care plan with you and your family. Your care plan includes:

• The services you need
• Who will deliver the services
• How often you need the services
• Any equipment needed to reach your goals
• Food options
• Other necessary details

Nursing

• Carries out medical orders from the physician as well as providing nursing care

Physical Therapy

• Focuses on strengthening large muscle groups (anything from the waist down) Walking / Sitting / Standing / Stairs etc.

Occupational Therapy

• Focus is on improving fine motor skills (anything from the waist up) Ability to hold eating utensils/brushing hair and teeth/dressing oneself, etc.

Speech Therapy

• ​​If necessary, focus is on speech improvement or swallowing ability (typically needed after a patient has suffered from a stroke)​

The qualifications needed to be covered by Medicare in a Skilled Nursing and Rehabilitation Center include: 

• Beneficiary must have a three-day qualifying hospital stay.
• Admitted to the health care center within 30 days of a hospital discharge.
• Have unused Medicare Part A days.
• Have a diagnosis covered by Medicare.

How can I get Medicare Coverage in a Skilled Nursing and Rehabilitation Center?

To receive services, you must use a Medicare-certified skilled nursing facility. Medicare Part A provides 100 days of coverage per benefit period. Your benefit period begins the day you start receiving hospital or skilled nursing facility benefits:

• The first 20 days are fully covered by Medicare Part A.
• For the remaining 80 days, Medicare covers all charges except for the co-insurance amount.

It’s important to note that you are not limited to a specific number of benefit periods. However, to qualify for another 100-day Medicare benefit period, you must have another three-day hospital stay and continue to meet Medicare requirements.

Will I Remain on Medicare Part A for the Full 100 Days?

A patient will remain on Medicare, Part A, as long as it is medically necessary. If at any point during the patient’s stay their health improves and their diagnosis no longer supports Medicare coverage, they will either be discharged or change payor types.

How Do I Qualify for a New 100 Days of Coverage?

The beneficiary must go 60 consecutive days without receiving skilled care. After the sixty-day period, the beneficiary qualifies for another 100 days of care if they meet the pre-mentioned criteria.

What is Co-insurance?

Co-insurance, also known as percentage participation, helps cover the cost of services not fully paid by Medicare after your initial 20 days of coverage. There are typically three sources of co-insurance:

1. Medicaid
2. Private Insurance Company
3. The Patient

Ultimately, the patient is responsible for paying the co-insurance.

What Services Does Medicare Part B Pay for?

Medicare Part B pays for the following services when the patient is no longer covered by Medicare Part A:

1. Physical Therapy
2. Speech Therapy
3. Occupational Therapy

Additionally, Medicare Part B covers many medically necessary services that Part A does not. However, there is a 20% co-insurance amount that Medicare Part B does not cover.