Medicare Skilled Nursing Secret

Learn how Skilled Nursing Facility care works

by Katie Banks+ on Jul 11, 2014 | 7 Comments

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Original Medicare offers some benefits for Skilled Nursing Facility care. Unfortunately, few people understand what SNF is and how it works. First, you should know that Skilled Nursing Facility care is not Custodial Care, which refers to nurses that ONLY help people get in and out of bed, feed them, bathe them, help them put on clothes and use the bathroom. Medicare doesn’t cover Custodial Care.

What is Skilled Nursing?

Skilled Nursing is basically inpatient rehab. Physical, occupational, and speech Therapy are examples of Skilled Nursing. Nearly anything that helps treat and manage your post hospitalization will fall under this category as long as it takes place at a Skilled Nursing Facility.

Medicare Covers some Skilled Nursing

Original Medicare covers 100% of Skilled Nursing for the first 20 days per benefit period. The next 80 days you are required to pay $176 per day. If you need more than 100 days of Skilled Nursing you will have to pay for any extra days out of your own pocket.

If you are enrolled in a Medicare Supplement insurance plan (Medigap), most will cover all or part of the Skilled Nursing Facility coinsurance. A Medigap plan could save you up to $12,160.

Learn More about Medigap Get a Medigap QuoteApply for Medigap

Skilled Nursing Facility’s “Dark” Secret

Before Medicare covers your Skilled Nursing Facility care you need a 3 day qualifying hospital stay. This means 3 consecutive days or more, starting with the day the hospital admits you as an inpatient, but not including the day you leave the hospital. If you don’t have 3+ days as an admitted patient (hospital observation does not count), you will have to pay 100% of your inpatient rehab.

Many people who are not aware of this hospital rule find themselves with large bills not covered by Medicare AND their Medigap policy. Additionally, you must require the skilled care on a daily basis to qualify for Skilled Nursing Facility care.

Advice for Skilled Nursing Facility Care

The following is advice to receive the best Skilled Nursing Facility care:

  • Make sure you are officially admitted to the hospital for 3 full days before seeking skilled nursing treatment. Hospitals often list patients as under observation and this will not count towards the requirement.
  • Consider a Medigap plan to pay for the Skilled Nursing portion not covered by Medicare. Medigap plans C, D, F, F-high deductible, M and N all cover 100% of the $176 daily copay for an additional 80 days per benefit period.
  • Consider a Long Term Care (LTC) policy if you are interested in custodial care.

For further questions about Skilled Nursing Facility care call the number above or if you’re interested in learning more about Medigap policy click here to get an instant Medicare Supplement quote.

Learn More about Medigap Get a Medigap QuoteApply for Medigap

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Reader Comments and Questions

By ernest on February 07, 2020

does plan f cover skilled nursing costs

Ernest,
It does. Those without Plan F would have to first pay the Part A Deductible and then $176 for the days 20-100 days. A Medigap plan F would cover the Part A deductible and all skilled nursing costs for the first 100 days.

Contact us to enroll in Medigap Plan F at no additional cost to you. You can also apply online here.
-Michelle from Senior65.com


By Dave on October 14, 2019

A friend is in the hospital,3 weeks as of now.she is headed to a skilled nursing and rehab center. Told she is covered for 100 days.she has a supplemental .can she be covered for more than 100 days depending on her supplemental .

Dave,
100 days is the maximum days covered by Medigap. Medicare rarely lets a client stay up to 100 days in skilled nursing as they must show progress to stay. So it is difficult to exhaust. Hope that helps.
-Eric from Senior65.com


By James on August 05, 2019

I am 80 and have Medicare and Medigap with Mutual of Omaha plan g....will this cover if I need a nursing home?

James,
While Medigap doesn't cover Nursing home expenses, it will provide key coverage at the hospital and doctor that is not paid for by Medicare. You will definitively want to keep it even if you are staying at a nursing home.
-Eric at Senior65.com


By Tracy on July 07, 2019

I am 65,I signed up for Medicare B last September. I would like to switch to plan G, how and when can I do this?

Tracy,
You can do so at any time by submitting a new application. In most states, you will have to answer medical questions and could be turned down for pre-existing conditions.

If you don’t fall under one of the states that offer guaranteed switching period, call us at 800-930-7956. We can match you with the best Medigap insurance company based on your current health status. To learn more about switching check out our article on Switching.
-Michelle from Senior65.com


By Sally on November 07, 2018

If I purchase a medicare supplement after I have been in the hospital three days and in the skilled nursing rehab for 15 days, will it pick up the additional 80 days as long as I have had creditable coverage?

Sally,
This is the first time we have been asked this question. Medicare Supplement providers typically would not approve your application if you were currently in a skilled nursing facility. The exception is if you are in a guaranteed issued/ special enrollment period. If so, give us a call and we can confirm your question with the insurance provider when we help you enroll.
-Michelle from Senior65.com


By Eugene on August 16, 2018

My brother who has the best of Medicare supplement insurance had a stroke in March,2018. He spent a few months in a hospital recieving sparatic treatment,which helped slightly.He was then transferred to a therapy facility and improved also slightly. He was released after a few weeks and was sent home where he received therapy daily,but the service has stopped and his improvement seems small. Is there another means by which he can receive therapy as he seems able to understand but it seems to be a very slow and futile journey.

Eugene,
There is not another insurance that we know of to cover additional therapy if it is not approved by Medicare. Our recommendation would be to appeal to Medicare to extend his therapy.
-Chris from Senior65.com


By Erik on May 25, 2018

Hi, I am turning 65 soon and had a few questions. 1.) If I go with a medigap policy plan F will it pay for the skilled nursing facility after day 80? 2.) Am I allowed to change my policy when I turn 65? For example I enroll into an Aetna plan on 5/15 (proposed effective date) 6/1. Can I switch my plan if I find a better one or do I have to wait until the "annual enrollment period"? 3.) My neighbor has employer coverage w/o drug coverage (medical only) can he keep that employer plan and just enroll into a PDP plan? Thanks in advance, Erik J

Erik,
Question 1) No, Plan F will not extend benefits beyond 80 days but it will pay all deductibles and coinsurance for the first 80 days.
Question 2) Yes. You can switch during the first 6 months of your initial enrollment period.
Question 3) Yes, he should be able to enroll in a PDP only plan.

If you need help enrolling (or comparing prices) in a plan, please call us here at senior65.com.
-Chris from Senior65.com










PLEASE NOTE: We cannot comment on specific Medicare claims. Contact Medicare directly if you are trying to see if your issue is covered.

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