There are many reasons why someone might require skilled nursing facility (SNF) care. It could be to improve your condition, maintain your current condition, or prevent your condition from getting any worse. Unfortunately, these facilities also cost a lot of money. Medicare has health plans that can help cover some of the costs associated with SNF care. While it can be a bit confusing to navigate its various plans, an online search can help you understand what’s covered by Medicare.
There are certain conditions that Medicare customers must meet in order to qualify for SNF care coverage. To find out what these conditions are start an online search.
XH2 / ShutterstockHere’s what you need to know about SNF coverage with Medicare.
What is Considered Skilled Nursing Facility Care?
Skilled nursing facility care are services that can only be done safely by a professional or technical personnel.¹ Medicare says the purpose of this form of healthcare is to treat, manage, and observe your condition and evaluate your care.
Skilled nursing professionals include:
- Registered nurses;
- Licensed practical and vocational nurses;
- Physical and occupational therapists;
- Speech-language pathologists, and;
- Audiologists.
Everything else is considered custodial care, which is not considered a skilled nursing facility. Custodial care includes the various tasks required for everyday activities. Some examples include:
- Maneuvering in and out of bed;
- Bathing;
- Dressing, and;
- Using the bathroom.
Certain care that a person can usually do themselves such as eye drops is usually considered custodial care.
Does Medicare Cover Skilled Nursing Facilities?
Now that you know what is considered SNF care, it’s time to know whether or not Medicare covers it. The answer is yes. However, there’s some important requirements you need to understand.
SNF care falls under the Medicare Part A plan.² This health plan covers things like inpatient care in a hospital, nursing home care, hospice care, and home health care. Skilled nursing care is covered under certain conditions on a short-term basis.
Medicare has very specific conditions for providing coverage on SNF care. In order to qualify, a person must meet all of the following criteria:
- You have Part A insurance and days left in your benefit period to use.
- You have qualifying hospital stay.
- Your doctor has deemed daily skilled care medically necessary.
- The skilled services are being received in an SNF that’s certified by Medicare.
- You require skilled services for a medical condition that’s either a hospital-related medical condition treated during inpatient stay or a condition that started while you were getting care in the SNF for a hospital-related medical condition.
How Much Will Medicare Cover?
Medicare covers a lot of the expenses for SNF care, but not all of it depending on the duration of your stay. The insurer will cover you for up to 100 days in a benefit period, as long as you continue to meet the requirements previously mentioned.
With an Original Medicare plan, you pay $0 for days one to 20 for each benefit period. Days 21 to 100 cost $185.50 coinsurance per day of each benefit period. If you require SNF care for more than 100 days, you will be responsible for paying all costs out-of-pocket.
Remember, costs can vary depending on your exact plan and amount of coverage. Doctors or health care providers might even recommend you get services that Medicare does not cover. To find out whether you will have to pay more money, make sure to clarify exactly what medical attention you require.
Find the Medicare Plan for Your Needs
Medicare is meant to make healthcare more affordable. As such, each plan covers a different set of health services. To help, here is a rundown of what each plan covers:³
- Part A: Hospital insurance that covers inpatient hospital stays, care in a nursing facility, and hospice care.
- Part B: Insurance that covers medically necessary and preventative services.
- Part C: A Medicare Advantage plan that provides you with both Part A and Part B coverage.
- Part D: Prescription drug coverage.
- Medigap: Supplement insurance sold by private companies that can help pay for remaining costs that your Medicare plan does not cover, including copayments, coinsurance, or deductibles.⁴
If you require SNF care, make sure your plan includes Part A. To find more details, search online to find the Medicare healthcare plan that’s right for you.