Does Medicare Cover Skilled Nursing Care?

Does Medicare Cover Skilled Nursing Care?

There might come a time in your life when you need a little extra care — even if it's only for a short time. That care can come in many forms. You could hire a home health aide to help get you back on your feet after an injury. Or, if you need supervised short-term health care, you could consider a skilled nursing facility.

A skilled nursing facility can give you the care you need when you need it. But there's one important factor to consider: cost.

If you're wondering, "Does Medicare cover skilled nursing care?" you're not alone. And it does — but only to a point. Understanding how — and how much — Medicare covers skilled nursing facilities is important as you plan for retirement and plot out any potential long-term care needs. Here's what you need to know.

What Is a Skilled Nursing Facility?

A skilled nursing facility is primarily an inpatient rehabilitation and treatment center. It employs licensed medical professionals, such as doctors, registered nurses and physical and occupational therapists, who help patients rehabilitate from injuries or recover from illnesses.

A skilled nursing facility is not the same as a nursing home, which is designed as a permanent living situation for patients who need round-the-clock medical and custodial care.

Does Medicare Cover Skilled Nursing Facilities?

Yes, Medicare covers skilled nursing care, but only under certain conditions and only for a limited time.

Medicare Part A covers inpatient hospital care, and it also covers home health care and hospice care. It covers skilled nursing care, too, but it only covers short-term stays at skilled nursing facilities if you meet the following conditions:

  • You are enrolled in Medicare Part A.
  • You have days remaining in your benefit period, which begins the day you're admitted to a hospital or a skilled nursing facility and ends after you've been out for 60 consecutive days.
  • You have a qualifying hospital stay, meaning you were formally admitted to the hospital and stayed there for at least three consecutive days.
  • Your doctor has diagnosed you with a medical condition that is related to or was treated during your qualifying hospital stay, or a medical condition that appeared while you were receiving care in a skilled nursing facility for a hospital-related condition.
  • Your doctor has decided that you need daily care that can only be given by or under the supervision of skilled nurses.
  • You receive care in a skilled nursing facility that's covered by Medicare.

Even if you're approved for skilled nursing care, there are coverage limits. Medicare covers all costs during the first 20 days of treatment during each benefit period. During days 21 to 100, you pay a daily coinsurance. Past 100 days, you pay the full cost of all services.

If you hit 60 consecutive days without any hospital stays, you're eligible for Medicare coverage of skilled nursing facilities again.

How Can I Pay for Skilled Nursing Care?

Covering these costs can get expensive. Here are a few things to consider when looking into paying for skilled nursing care.

  • Check with your doctor to determine whether you can receive outpatient or at-home care. These are often more affordable options, and Medicare typically covers them.
  • Consider long-term care coverage. Depending on your policy, it might cover the costs of an extended stay at a skilled nursing facility.
  • Think about moving. The daily costs of care can fluctuate dramatically; living in a state where care is more affordable could leave more savings available for extended stays.
  • If your income is limited, look into Medicaid. Check with your local office to see whether you qualify.

Make Sure You Have the Coverage You Need

As you approach retirement, you need to consider all your options. You'll have choices about the types of coverage available to you, so look at your lifestyle, your retirement savings and any plans you've made around long-term care when selecting an insurance policy.

Once you've reviewed your options, you'll be able to make an informed choice about the best approach for you and your family.

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