Twin City Underwriters

Does Medicare Cover Nursing Facilities?

November 19, 2018 | Debby Jesser

Are you wondering if Medicare will pay for nursing facility care? We are here to clear up any confusion and explain what requirements must be passed in order to receive nursing care cost assistance from Medicare and what exact nursing care can be provided by Medicare. 

Requirements

You must meet two requirements before Medicare will pay for any nursing facility care.

  • Requirement 1: You must have recently stayed in a hospital
  • Requirement 2: Your doctor must verify that you require daily skilled nursing care

Requirement Details

Your stay in a skilled nursing facility must follow at least three consecutive days, not counting the day of discharge, in the hospital (however, some Medicare Advantage plans will waive the three consecutive days rule). You must have been actually “admitted” to the hospital, not just held “under observation.”

NOTE: Time spent on an outpatient or observation basis does not trigger the beginning of a benefit period

In addition, your stay in the nursing facility must begin within 30 days of being discharged from the hospital. If you leave the nursing facility after coverage begins, but are readmitted within 30 days, the second period in the nursing facility will also be covered by Medicare.

Note: Each benefit period begins on the day a Medicare beneficiary is admitted to the hospital on an inpatient basis. A benefit period ends when the beneficiary has not received inpatient hospital or SNF care for 60 consecutive days. Once a benefit period ends, a new one can begin the next time the beneficiary enters the hospital. There is no limit to the number of benefit periods a beneficiary can have.

Medicare Coverage

The beneficiary has Medicare Part A (hospital insurance) and days left in their benefit period available to use. There are limitations on the number of days you can receive benefits.

What Skilled Nursing Services Will Medicare Cover?

The nursing facility care and services covered by Medicare include:

  • Semiprivate room (two to four beds per room), or a private room if medically necessary
  • All meals, including special, medically required diets
  • Regular nursing services
  • Special care units, such as coronary care
  • Drugs, medical supplies, treatments, and appliances provided by the facility, such as casts, splints, wheelchair, and rehabilitation services. Rehabilitations services (provided in the nursing facility) can include: physical therapy, occupational therapy, and speech pathology.

Medicare Supplemental Plans (Medicare Supplements / Medicare Advantage Plans)

Some supplemental Medicare plans may have additional benefits or qualifying guidelines about what Medicare covers.  Checking the summary of benefits of each plan will describe guidelines and limitations. Do you have questions about the summary of benefits for your plan? We would love to assist you and answer any questions you may have concerning Medicare!