Medicare will cover skilled nursing care if all the following are true:
- You have Medicare Part A (Hospital / Institutional Insurance) and have days left in your benefit period.
- You have a qualifying hospital stay. This means an inpatient hospital stay of 3 consecutive days or more. You must enter the Skilled Nursing Facility (SNF) within a short period of time of leaving the hospital.
- Your doctor has ordered the services you need for SNF care, which require the skills of professionals such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech-language pathologists, etc.
- You require the skilled care daily and the services must be ones that can only be provided in a SNF on an inpatient basis.
- You need these skilled services for a medical condition that:
- Was treated during a qualifying 3-day hospital stay, or
- Started while you were getting SNF care for a medical condition that was treated during a qualifying 3-day hospital stay.
- Your Costs in Original Medicare (your responsibility):
- Days 1-20 $0 for each benefit period (no cost patient responsibility)
- Days 21-100 $185.50 per day Coinsurance in 2021 (patient responsibility)
- Days 101 and beyond all costs (all costs are the responsibility of the patient)
Does Medicare cover Long Term Care Facilities?
No, Medicare does not cover care in a Long-Term Care Facility.