What does Medicare Cover in a Rehab Nursing Home?

Medicare Part A (Hospital Insurance) will cover Skilled Nursing Care in a Skilled Nursing Facility (SNF)under certain conditions for a limited period of time. A Skilled Nursing Facility is also commonly known as a “Rehab Facility” or a “Nursng Home”, same thing.

In order for you to access these Med A benefits you must have a 3 night qualifying stay as an inpatient resident of a Hospital. Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you’re getting observation services in the hospital, you’re considered an outpatient—you can’t count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay. Find out if you’re an inpatient or an outpatient.

The benefits period under Medicare A in a SNF is 100 days, which is in addition to the 100 Hospital days you get under Medicare A.  The first 20 days in a SNF are covered in full at 110%. Day 21-day 100 are covered at 80% with the patient being billed for the 20%. It is wise to carry a Medicare Supplement policy such as BC/BS Medex that covers the 20% medicare does not. This is commonly known as a Medi-Gap policy.

Getting the full 100 days of the benefit period is not guaranteed. A frequent evaluation is done by the nursing facility staff to determine you still meet the criteria and need Skilled Nursing Facility Services. Usually the Nursing Home is working in your best interests also to keep you on you benefit period because they get paid good money while you are considered Skilled, however they are heavily audited and must be able to justify the need of Skilled care. Usually once someone “Plateaus” as they call it, they have rehabed tot he pont they are able to return home to the community, however some residents are advised that they are not safe to return to the community and should transition to long-term custodial care within the same facility. Custodial care is not covered by Medicare rather it is Private Pay or you must apply for Medicaid Coverage.

 

Medicare-covered services include, but aren’t limited to:

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