Someday it could happen and you need the services of a Skilled Nursing Facility (SNF). Whether you are enrolled in Original Medicare or an Advantage Plan you should have a basic understanding of the requirements, because these facilities can become quite expensive and might become your financial responsibility.
What is a SNF?
A Skilled Nursing Facility is a health care facility that is licensed and inspected by your State Health Department. These facilities offer both short and long term services.
Services vary from one facility to another and there is a possibility that Medicare or your Advantage plan may not pay for these services. You or your caretaker should take the time to confirm what services will be covered. Here are some of the services:
- Medical treatment prescribed by a doctor
- Physical therapy
- Speech therapy
- Occupational therapy
- Assistance with personal care activities such as eating, walking, bathing, and using the toilet (custodial care)
- Case management
- Social services
Some SNFs offer:
- Specialized care programs for Alzheimer's or other illnesses/conditions
- Short-term respite care for very frail or disabled persons when a family member requires a rest from providing care in the home
What are Medicare’s Requirements?
Medicare has requirements for you to be admitted to a SNF.
- Your hospital stay must be at least 3 days to qualify for a Skilled Nursing Facility and it cannot include your discharge date.
- You must enter the SNF within 30 days of your hospital stay
- The SNF must be ordered by a physician
- The level of care must be supervised by a professional such as a registered nurse, licensed practical nurse, physical therapist, or intravenous injections.
- The level of skilled care provided cannot be obtained at home or on an outpatient basis
What Does Medicare Pay and How Long Can You Stay?
- From Days 1 - 20: you pay $0 each day
- From Days 21 - 100: you may have to pay up to $137.50 each day
- Beyond 100 days you are responsible for 100% of the costs.
Medicare care also caps your stay at 100 days of Medicare Part A coverage for each benefit period.
Being admitted to a skilled nursing facility can be expensive and can become your responsibility as Medicare generally does not cover long-term stays in a nursing home.
If you have original Medicare the co-payment is generally paid by a Medigap policy if you have one.
If you or your caretaker has a question, contact Medicare. Call 1-800-MEDICARE (1-800-633-4227) and TTY users should call 1-877-486-2048
Medicare Advantage Plan enrollees or their caretakers should contact their plan to get complete information on what is covered, for how long and what, if any, out of pocket charges you are responsible for.