In some situations Medicare will cover some of the cost of your stay in a nursing home. Admission to the nursing home must follow a qualfied stay or at least 3 days as an inpatient in a hospital.
If Medicare approves your claim for a stay in a skilled nursing facility, your Medigap plan will pay their portion.
Medigap plans C, D, F, G, M, and N will pay skilled nursing facility coinsurance, but only if Medicare will cover the stay. Medigap plans K and L pay a percentage of the coinsurance if Medicare will cover the stay.
Medicare does cover some inpatient skilled nursing care, but only if
1. it’s necessary to treat an improving medical condition AND
2. services are provided at a Medicare approved facility AND
3. the person spent at least 3 days as an admitted inpatient at a hospital. (Note: many Medicare beneficiaries that go to the hospital are coded for an observational stay, due to stricter governance by CMS over higher cost reimbursements for inpatient admissions. If a patient is coded for an observational stay, and not an inpatient admittance for at least 3 days, they are not eligible for the skilled nursing benefit. Over 1 million Medicare beneficiaries lost SNF benefit last year due to observation coding).
Medicare skilled nursing benefit: Medicare pays up to 100 days of skilled nursing facility (SNF) care if the qualifications are all met, days 1-20 in full, days 21-100 subject to $161 per day patient co-insurance (2016).
If a doctor places an individual in a hospital or skilled nursing facility when the kind of care the individual needs could be provided elsewhere (i.e. at home or a non-skilled care facility), the individual’s SNF stay will not be considered reasonable and necessary, and Medicare will not pay for it. If an individual stays in a hospital or skilled nursing facility longer than necessary, Medicare payments will end when inpatient care is no longer reasonable or necessary. Medicare also does not cover the stay if the patient needs only custodial care, i.e. assistance with activities of daily living.
.JPG){kind=avatar}
If Medicare approves your claim for a stay in a skilled nursing facility, your Medigap plan will pay their portion.
Medicare does cover some inpatient skilled nursing care, but only if
1. it’s necessary to treat an improving medical condition AND
2. services are provided at a Medicare approved facility AND
3. the person spent at least 3 days as an admitted inpatient at a hospital. (Note: many Medicare beneficiaries that go to the hospital are coded for an observational stay, due to stricter governance by CMS over higher cost reimbursements for inpatient admissions. If a patient is coded for an observational stay, and not an inpatient admittance for at least 3 days, they are not eligible for the skilled nursing benefit. Over 1 million Medicare beneficiaries lost SNF benefit last year due to observation coding).
Medicare skilled nursing benefit: Medicare pays up to 100 days of skilled nursing facility (SNF) care if the qualifications are all met, days 1-20 in full, days 21-100 subject to $161 per day patient co-insurance (2016).
If a doctor places an individual in a hospital or skilled nursing facility when the kind of care the individual needs could be provided elsewhere (i.e. at home or a non-skilled care facility), the individual’s SNF stay will not be considered reasonable and necessary, and Medicare will not pay for it. If an individual stays in a hospital or skilled nursing facility longer than necessary, Medicare payments will end when inpatient care is no longer reasonable or necessary. Medicare also does not cover the stay if the patient needs only custodial care, i.e. assistance with activities of daily living.