How does Medicare cover Skilled Nursing?
Long Term Care? * Home Health Care?
Skilled nursing facility care
Medicare covers semi-private rooms, meals, skilled nursing and rehabilitative services, and other medically necessary services (Clinical Guidelines) and supplies furnished in a skilled nursing facility after a 3-day minimum, medically necessary, inpatient hospital stay Medicare Policy Manual for a related illness or injury. An inpatient hospital stay begins the day the hospital formally admits you as an inpatient based on a doctor’s order and doesn’t include the day you’re discharged. You may get coverage of skilled nursing care or skilled therapy care if it’s necessary to help improve or maintain your current condition.
To qualify for skilled nursing facility care coverage, your doctor must certify that you need daily skilled care (like intravenous injections or physical therapy) which, as a practical matter, can only be provided in a skilled nursing facility if you’re an inpatient.
You pay:
• Nothing for the first 20 days of each benefit period
• $185 Coinsurance per day for days 21–100 of each benefit period
• All costs for each day after day 100 in a benefit period Medicare.Gov SNF *
Note: Medicare doesn’t cover long-term care or custodial care.
- Skilled nursing facility care coverage
- Skilled Nursing Facility Checklist [PDF]
- Assessments
- Care plans
- Your rights in a skilled nursing facility
- Reporting & resolving problems
- Get help paying for skilled nursing facility care
- Find hospitals & skilled nursing facilities
Resources & Links
medicare.gov/-skilled-nursing-facilities
Pamphlet on Skilled Nursing from Medicare
Authorized Agent
Email us [email protected]
Blue Shield Authorized Agent
No extra charge to you -
Learn more and #enroll online
Paper Application
MAPD Medicare Advantage
* Short Form - Transfers 65 Inspire, Plus, Choice & Trio
Home health services
You can use your home health benefits under Part A and/or Part B to pay for home health services. Medicare covers medically necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, or continued occupational therapy services. A doctor, or certain health care professionals who work with a doctor, must see you face to-face before a doctor can certify that you need home health services. A doctor must order your care, and a Medicare-certified home health agency must provide it.
Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment, and medical supplies for use at home. You must be homebound, which means:
• You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
• Leaving your home isn’t recommended because of your condition.
• You’re normally unable to leave your home because it’s a major effort.
You pay nothing for covered home health services. You pay 20% of the Medicare-approved amount, and the Part B deductible applies, for Medicare covered medical equipment. copied from Medicare & You – see brochure in side panel *
Skilled Nursing Official Booklet
Home Health Official Booklet
True Freedom Plans
"Prepaid Home Health Care?"
Watch 3 minute simple plain English Video
Email us for more information [email protected]
Our webpage on Long Term & Home Health Care
Our webpage on True Freedom
Medicare & #HomeHealth Care # 10969
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TRUE FREEDOM - Home Health Care
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Help!
I’ve been in the hospital, skilled nursing, etc. since November. Due to an infection my toes were amputated. I need physical therapy, skilled nursing, home health care, Medi Cal, IHSS, I don’t know what all.
What programs and guarantees are available to me.
I also have Blue Shield 65 Plus HMO, how is it better and differ from original Medicare?
Here’s our webpage on physical therapy
Here’s the EOC Evidence of Coverage for Blue Shield 65 Plus
Please note that MAPD Medicare Advantage plus must give you equal or better benefits than original medicare!
Skilled Nursing
Note – Medicare is $185/day co-pay for days 21 to 100.
Home Health Care Agency
See the brochure above on Medicare eligibility and benefits of Home Health Care
See the Blue Shield EOC for their rules, details and appeals process. Try Ctrl – F to search.
Skilled Nursing not medically necessary
See above for the Medicare Pamphlet & Video on Home Health Care
Medi Cal Aged & Disabled Program
Medi Cal IHSS In Home Supportive Services
Appeals & IMR Independent Medical Review
Do ObamaCare/ACA policies cover Skilled Nursing? How long?
Skilled Nursing Facility Benefits
Benefits are provided for Skilled Nursing services in a Skilled Nursing unit of a Hospital or a freestanding Skilled Nursing Facility, up to the Benefit maximum as shown on the Summary of Benefits.
The Benefit maximum is per Member per Benefit Period, except that room and board charges in excess of the facility’s established semi-private room rate are excluded.
A “Benefit Period” begins on the date the Member is admitted into the facility for Skilled Nursing services, and ends 60 days after being discharged and Skilled Nursing services are no longer being received.
A new Benefit Period can begin only after an existing Benefit Period ends Specimen Policy
Summary of Benefits
Skilled nursing facility (SNF) services Up to 100 days per member, per benefit period,
What about “Rehab?”
Here’s the best explanation that we found on Nolo’s website.