Skilled Nursing Care is health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care.
You get skilled nursing care to:
- Help improve your condition, or
- Maintain your current condition and prevent it from getting worse.
- Help improve your condition within a predetermined time period, or
- Set up a maintenance program designed to maintain your current condition and prevent it from getting worse.
Skilled care helps you get better, function more independently, and/or learn to take care of your health needs. You and your family will be able to take part in setting your health goal.
Medicare will only cover skilled care when you meet certain conditions.
It is given in a Skilled Nursing Facility. Medicare covers certain skilled care services that are needed daily on a short-term basis (up to 100 days). Skilled care requires the involvement of skilled nursing or rehabilitative staff in order to be given safely and effectively.
MEDICARE WILL COVER SKILLED CARE ONLY IF ALL OF THE FOLLOWING ARE TRUE:
- You have Medicare Part A (Hospital Insurance) and have days of SNF coverage left in your benefit period. You get 100 days of SNF coverage per benefit period.
- You have an inpatient stay of 3 consecutive days or more (a "qualifying stay"), counting the day of inpatient admission to the hospital, but not the day of discharge, before being admitted to the SNF.
- The SNF is certified by Medicare.
- You begin getting covered care in the SNF within a short time (generally, 30 days) after discharge from the qualifying 3-day hospital stay.
- Your doctor has ordered the services you need for SNF care.
These services must meet the following criteria:
- Require the skills of professional personnel
- Be needed on a daily basis
- Be a type of care that can be provided only in a SNF on an inpatient basis
- Be needed for a "hospital-related condition" (that is, one of the conditions that was treated during the qualifying 3-day hospital stay, even if not the main reason for that stay), or be needed for a condition that arose in the SNF while you were being treated there for a hospital-related condition – Be reasonable and necessary
Medicare covers the following services:
- Semi-private room
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Medical supplies and equipment used in facility
- Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren't available at the SNF
- Dietary counseling
WHAT DO I PAY?
You pay nothing for covered services the first 20 days that you're in a Skilled Nursing Facility. You pay a co-payment for days 21-100, and you pay all costs beyond 100 days.