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Skilled Nursing Facility Care Medicare Coverage Detailed

Your Medicare Coverage

Skilled Nursing Facility Care Detailed

Coverage: Conditions that must be met before Medicare will provide coverage, and limits to coverage.

Medicare covers skilled care in a skilled nursing facility (SNF) under certain conditions for a limited time. Skilled care is health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. Examples of skilled care include changing sterile dressings and physical therapy. It is given in a Medicare-certified SNF. Care that can be given by non-professional staff is not considered skilled care. Medicare covers certain skilled care services that are needed daily on a short-term basis (up to 100 days).

Medicare will cover skilled care only if all these conditions are met:

  1. You have Medicare Part A (Hospital Insurance) and have days left in your benefit period to use.
  2. You have a qualifying hospital stay. This means an inpatient hospital stay of 3 consecutive days or more, not including the day you leave the hospital. You must enter the SNF within a short time (generally 30 days) of leaving the hospital. After you leave the SNF, if you re-enter the same or another SNF within 30 days, you don't need another 3-day qualifying hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start getting skilled care again within 30 days.
  3. Your doctor has decided that you need daily skilled care. It must be given by, or under the direct supervision of, skilled nursing or rehabilitation staff. If you are in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week.
  4. You get these skilled services in a SNF that has been certified by Medicare.
  5. You need these skilled services for a medical condition that:
    - Was treated during a qualifying 3-day hospital stay, or
    - Started while you were getting Medicare-covered SNF care. For example, if you are in the SNF because you had a stroke, and you fall and sprain your wrist.

Please refer to the coverage information under Home Health Care for information about skilled nursing care given by a Home Health Agency in your home.

CoPayment: The amount you need to pay.

You pay the amounts below for each benefit period in 2003 following at least a 3-day covered hospital stay:
Days 1 - 20: $0 for each day.
Days 21 - 100: $105.00 for each day.
Days over 101: You pay 100%.

There is a limit of 100 days of Medicare Part A SNF coverage in each benefit period.

Effective January 1, 2004 the amounts you pay for each benefit period will increase to the following amounts:
Days 1 - 20: $0 for each day.
Days 21 - 100: $109.50 for each day.
Days over 101: You pay 100%.

A benefit period begins the day you go to a hospital (or under special circumstances, a skilled nursing facility). The benefit period ends when you have not received any hospital (or skilled care in a SNF) for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods you can have.

Medicare Part: The part of Medicare that pays for this service or supply.


Organization Name: The organization name that this coverage topic is associated with.

Important Notes: Details regarding important notes about the coverage.