What Does the Medicare Skilled Nursing Benefit Cover?

What Does the Medicare Skilled Nursing Benefit Cover?

Mar 09, 2020

Are you concerned about how to pay an aging loved one’s short-term rehab?

If your loved one is age 65 or older, he or she may be eligible for certain benefits through Medicare. But what exactly does the skilled nursing benefit cover? And who is eligible to apply?
Understanding the Medicare Skilled Nursing and Rehab Benefit

If your loved one needs skilled nursing care following a hospital stay of at least three nights and he or she participate in Medicare, they can use their benefit to pay for skilled nursing care and related costs.

In most cases, Medicare should cover:

  • room and board
  • skilled nursing care
  • physical therapy
  • dietary counseling, if required to meet health goals
  • speech-language pathology services
  • medication (separate from Medicare Part C prescription coverage)
  • medical supplies and equipment used within the facility
  • ambulance transportation (if deemed necessary)

 What Is Skilled Nursing Care?

Skilled nursing care must be administered by an RN or LPN/LVN and must be directly related to a person’s health and recovery. An RN or LPN/LVN can administer medications, expertly evaluate a patient’s condition, and perform intravenous injections. Skilled care may also include tube feedings, changing wound dressings, and health care education.

Additionally, skilled nursing care often involves physical, occupational, or speech therapy. 

Who Qualifies for Medicare Skilled Nursing Coverage?

If a Medicare A recipient has been in the hospital at least three nights, Medicare provides full coverage of skilled nursing care for up to 20 days, as long as it begins within 30 days of discharge from the hospital and is deemed necessary by a physician.

Medicare will continue to cover skilled nursing care for an additional 80 days, with a daily co-insurance payment that changes each year.

Loopholes to Watch Out For

If your aging loved one is in a hospital “under observation” but has not been admitted – even if they stay overnight – they might not meet the three-day minimum hospital stay. It’s important to ask about your loved one’s status, and to push for admission if you believe they might need skilled care following their hospital stay.

Likewise, if they refuse skilled care or physical therapy while in a short-term rehab center, they may be denied coverage.

If a loved one enters the hospital again before a period of 60 days, he may not be eligible for skilled nursing care coverage a second time.

From Hospital to Assisted Living

It’s important to note that Medicare does not cover Assisted Living services, which offer help with meals, support with the activities of daily living (ADLs), personal hygiene, getting dressed, and housekeeping.

But, depending on your loved one’s specific needs, they may be able to receive home health care services from a licensed Medicare agency in the privacy of their assisted living apartment. This allows them to get back on their feet in their own familiar surroundings!

To learn more about what you or a senior loved one is entitled to under Medicare, you can download an easy to read guide created by the Centers for Medicare and Medicaid Services.

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