In a simple world, a senior needing skilled nursing care would be referred by their doctor, provide their Medicare insurance information, and receive the care they need. Unfortunately, things are not so simple. Medicare will only pay for a skilled nursing facility (SNF) under certain conditions. Here are the basic requirements.
- You must have days remaining in your benefit period. This period begins the day you are admitted as an inpatient and ends when you haven't received any inpatient care for 60 consecutive days. You will be responsible for the deductible for each benefit period.
- You were an inpatient at a hospital for at least 3 days. The day you are formally admitted would be considered day 1 of a qualifying stay. Therefore, time spent receiving outpatient or observational services do not count.
- Your doctor has decided that you need daily skilled nursing care. Even if your stay is simply for skilled rehab that isn't offered daily, you must need and take advantage of these services each day that they are offered.
- The SNF must be certified by Medicare. So be sure to speak with the hospital social worker before agreeing on a specific facility.
- The condition for which you need SNF services must have either been treated in the hospital or have started while you were an inpatient in a hospital or SNF. It won't necessarily be the condition for which you were originally admitted.
For more detailed information, or to find out what your out-of-pocket costs might be, please visit the Medicare website.
At Caring Senior Service, our expert staff is comprised of extremely knowledgeable, friendly, and trusted professionals who take pride in helping your loved one manage their daily activities. Contact us today to learn more!