How much of my stay at a nursing facility will Medicare pay foradmin
Skilled nursing facilities (SNF) make it possible for patients to receive around-the-clock care without staying in a hospital or hiring an in-home care provider. However, if you or a loved one will stay in a SNF in the near future, you should know that Medicare coverage isn’t a guarantee. Your eligibility depends on the treatment you received before you were admitted, the type of treatment you’ll need during your stay, and a variety of other factors that are unique to your specific case.
Answer the following questions to get a better sense of your Medicare coverage requirements:
What kind of Medicare coverage do you have?
You must have Medicare Part A to qualify for any coverage at a SNF. This is the federal hospital insurance policy for patients 65 or older, and the terms are very specific. Before you explore some of the treatment and admission requirements that affect your individual eligibility, make sure you’re covered and haven’t exhausted your benefits yet.
Your Medicare Part A coverage must take effect before your hospital discharge, and you must have days remaining in your benefit period. This period begins when you’re admitted to the hospital and ends 60 days after your last inpatient or SNF service. Unless you’ve stayed in a hospital or SNF within the last 60 days, you’ll pay an inpatient deductible and a new benefit period will begin.
How Long Was Your Hospital Stay?
Medicare won’t pay for your stay in a SNF unless you had a qualifying hospital stay beforehand. To qualify, you must be in the hospital for inpatient treatment for at least three days before being admitted to the SNF. You don’t need to transfer directly from one to the next, but the SNF admission must happen within 30 days of your hospital treatment.
Your three-day inpatient requirement will not include your time in the hospital’s emergency department, nor the day of your discharge. You must be formally admitted to the hospital for inpatient services, then remain a patient for three days. If your doctor orders outpatient observation before your admission to a SNF, it won’t count toward your required hospital stay.
What Services Did Your Doctor Order
First and foremost, the care you receive at a SNF must be part of the same treatment plan you began at the hospital. For example, if you need rehabilitative treatment for a broken hip, your qualifying hospital stay must have been for the same injury. If you develop a condition or complication at the hospital, this may also qualify for treatment at an SNF.
Your doctor must actually order services that require skilled care from licensed professionals. Your SNF may have the following skilled caregivers on staff:
- Registered Nurses
- Licensed Practical Nurses
- Physical Therapists
- Occupational Therapists
- Speech Pathologists
- Registered Dieticians
As long as these professionals treat the same injury or condition that landed you in a hospital bed, your available skilled services aren’t limited to restorative treatments. Your caregivers may treat an illness or prevent complications to promote healing, but they may also help you maintain your current ability to function. Medicare also covers an ambulance if you need services elsewhere and can’t safely take other forms of transportation.
Do You Absolutely Need Daily Care
Medicare Part A only covers skilled services that are medically necessary and require you to stay at a SNF. If you can get the same services on an outpatient basis, from unskilled professionals, or less regularly, you may not qualify for coverage. Medicare will cover one or both of the following:
- 7 days a week of skilled nursing care (e.g. gastrostomy feedings, intravenous pain management)
- 5 days a week of skilled therapy services (e.g. therapeutic exercises, gait training, skilled assessment of potential outcomes and current needs)
Custodial care, which includes non-skilled personal care such as moving patients to chairs or feeding them by mouth, also qualifies for coverage if skilled professionals must provide it for safety reasons.
Is The Facility Certified By Medicare
As you research different facilities and consider your doctor’s recommendations, remember that your SNF must be a Medicare-certified facility. State and federal agencies work together to grant each certification of compliance, which requires an unannounced survey and official approval from the Centers for Medicare & Medicaid Services (CMS).
This certification criteria is designed to protect and uphold patient rights. The team of surveyors must be trained, tested, and include at least one registered nurse. Other team members will have skills relevant to the residents’ needs and the services provided. There are also federal and state-specific regulations for following up after surveys, responding to complaints, and monitoring facilities on an ongoing basis.
Will Medicare Cover A Stay At A Skilled Nursing Facility?
If you will be visiting San Diego, or traveling around the state once you arrive, Amtrak provides a comfortable and scenic way to do so. On board a train, you can see the sights, enjoy more legroom, and simply relax while getting to your destination. As an added bonus, Amtrak offers travelers age 62 and older a 15 percent discount on the lowest available rail fare on most of their trains, and all you need is a valid proof of age.