How to Explain the Medicare Skilled Nursing Benefit

The alphabet soup style labels that were intended to make it easier for seniors to understand their Medicare benefit often creates more confusion for them. Knowing what is covered under part B that isn’t covered under part A. Figuring out the co-pays after the deductibles for a hospital stay. It can all make even a seasoned discharge planner scratch their head.

Ann Jamison, Senior Advisor and Principal for Senior Living Options, can help. “We receive questions about Medicare every day in our work with families. In this article and in future ones, we will answer some of the most common Medicare benefit questions. We know the Skilled Nursing Benefit under Medicare Part A can be especially challenging for family caregivers to understand. We thought that seemed like a great place to begin our Medicare Q&A blog articles.”

Medicare Part A & Skilled Nursing Coverage

There are a few requirements you must meet for your skilled nursing and rehab stay to be covered by Medicare:

• You must have had a 3-night qualifying stay in a hospital within the last 30 days.
• You need to have been in the hospital at an inpatient level of care NOT in observation. You should double-check to make sure your 3 days were not considered observational.
• Your physician must order the rehab stay and believe you need daily care and the supervision of skilled nursing or rehabilitation staff.
• You must have days left in your benefit period. A benefit period begins on the day you are admitted to a hospital or a skilled nursing facility. It ends when you haven’t had any inpatient care for 60 days in a row.
  • If you return to a hospital or skilled nursing facility within this time frame, your benefits will be limited to the time you had left after your previous stay.
  • If you haven’t received inpatient care in the last 60 days, you must have another 3-night hospital stay to qualify for a new benefit period.

Once you have met the requirements outlined above, here is what you can expect to pay during your skilled nursing and rehabilitation stay under original Medicare:

Skilled Nursing Stay	You Pay in 2013
Days 0 – 20	$0
Days 21 -100	$148 daily coinsurance
Days 101+	All costs

 

If one of your clients or patients would like to learn more about the benefit, Medicare has a very comprehensive guide. Medicare Coverage of Skilled Nursing Facility Care offers very detailed information that can be easily downloaded for review.

What part of the Medicare benefit do you receive the most questions about from your patients and clients? Please comment below and we will address those concerns in a future blog post!

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