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Understanding Medicare Benefits in Skilled Care

Senior Couple Talking To Health Visitor At Home

Many people who receive Medicare have questions regarding when they can use these benefits.  If you, or someone you care for, requires skilled care for either a short-term rehabilitation or a long-term stay, it is vital to understand what is covered by Medicare, and what the client is expected to pay.  It is also important to note the skilled nursing community that you choose must be Medicare certified. 

Guidelines to Medicare Benefits for Skilled Care:

  • The Client would need a three (3) day qualifying hospital stay and meet other Medicare criteria in order to receive Medicare A benefits in a skilled nursing facility.
  • If a Client is admitted to a skilled nursing facility using Medicare A benefits and discharges before the 100 days allowed are used up and would need to return to a skilled nursing facility before 30 days are up from the date of discharge, the Client would qualify to use the rest of the Medicare A benefit days left over from the original admission as long as the Client meets other Medicare criteria such as receiving Occupational, Physical, or Speech Therapies.
  • If a Client has had more than a 30 day break from the discharge date of a skilled nursing service and has not had a 3 day qualifying hospital stay and needs to return to a nursing home, they would be private pay, and would not qualify for Medicare A benefits.
  • If a Client has had more than a 30 day break from the discharge date of a skilled nursing service but less that a 60 day break, and has had a 3 day qualifying hospital stay and meets Medicare criteria, they would admit to a nursing facility and use what ever days of Medicare A benefits are left from the original skilled nursing service.
  • If a Client has had a 60 day break from a skilled nursing service, and has had a 3 day qualifying hospital stay, and meets other Medicare criteria, i.e., requires Physical, Occupational, or Speech Therapies, they are entitled to the full 100 days of Medicare A benefit as long as they continue to meet Medicare criteria.
  • Medicare will pay days 1-20 at 100% in most cases. A supplement to your Medicare will be needed to pay for the $164.50 (2017) co-pay.  This is a basic guideline and your insurance would need to be verified at the time of admission.
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