Will Medicare Cover Skilled Nursing Facilities?

Yes, skilled nursing facility care is covered under Medicare Part A. Medicare covers qualifying skilled nursing facility stays for a certain length of time, provided you meet the necessary conditions. 

Medicare Covers Some Skilled Nursing Facility Care

Your Medicare Part A covers inpatient care in a hospital or Medicare-certified skilled nursing facility, along with hospice care and home health care. Skilled nursing care covered by Part A can include physical therapy, occupational therapy, speech-language pathology care, medical social services, medications, medical supplies and equipment, and ambulance services if needed, in addition to skilled nursing care, your room and your meals. Medicare will also cover any conditions, such as new infections, that you develop while at the skilled nursing facility.

Medicare does not cover long-term or custodial care. Skilled nursing facility care is not the same as nursing home care, although some inpatient services can be received in a nursing home and covered under Part A.

Qualifying Inpatient Hospital Stays

To get covered for care in a skilled nursing facility, you must first have a qualifying stay in a hospital. During your hospital stay, you must have been an inpatient for at least three days, not counting the day of your discharge. Time you spent under observation or in the emergency department does not count toward the three days of your qualifying stay. Once you are discharged, your doctor needs to order ongoing, 24-hour care at a skilled nursing facility for the condition you were under care for in the hospital.

The beginning of your inpatient stay marks the start of your benefit period.

Your Costs Per Benefit Period for Skilled Nursing Care

Skilled nursing care falls under your Medicare Part A coverage, so your Part A deductible, copayments and coinsurance apply. The Part A deductible charges $1,556 for each benefit period. Benefit periods start when you are admitted as an inpatient and end when you have not received inpatient care at your skilled nursing facility for 60 days in a row. If you leave the skilled nursing facility and need services before 60 days, your coverage will continue with the current benefit period.

Part A also charges you a daily coinsurance based on the length of your stay. For days 1 through 20 of your benefit period, you pay $0 in coinsurance once you have met your Part A deductible. For days 21 through 100, you pay $194.50 each day in 2022. After 100 days in your benefit period, you pay the full cost.

Are Medicare costs worrying you? Let the team at Magellan Healthcare help you find the Medicare plan near you with the most coverage at the lowest price. Contact us today to schedule an appointment.