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Medicare pays 100% for skilled nursing care for 20 days

How Many Days Will Medicare Pay for Skilled Nursing Care?

Skilled Nursing Care is a therapy or nursing service that must be done or supervised by a medical professional. This may include physical therapy, wound care, giving IV medication, bathing and hygiene, and more. While Skilled Nursing Facilities (SNF) can be located within hospital units, most of them are stand-alone or private units. These facilities usually provide many different types of services such as rehabilitation, short-term medical care, and long-term care.

However, the thought of paying for skilled nursing care can feel frightening. Many people start to question if or how long Medicare will cover skilled nursing care. While Medicare is not designed for long-term care, it can pay for skilled nursing care, but for how long?

How Many Days Will Medicare Pay for Skilled Nursing Care?

Medicare coverage for skilled nursing care is categorized into different benefit periods. The benefit period starts the day you are admitted to a skilled nursing facility as an inpatient—this benefit period expires when you don’t need skilled nursing care for 60 consecutive days. A new benefit period starts when you go back to the skilled nursing facility after the 60-day window. The costs that apply throughout the benefit period includes:

  • Day 1-20: During this benefit period, you won’t have to pay anything. Medicare covers the costs.
  • Days 21-100: Medicare pays for most of the cost, but you will pay a daily coinsurance, which is $185.50 per day as of 2021.
  • Day 101 and on: Medicare offers no coverage for skilled nursing care after 100 days. You must pay for the cost of care totally out of pocket.

Medicare Coverage for Skilled Nursing Facilities Rules

When considering Medicare coverage for skilled nursing facilities, Medicare has certain rules that Medicare beneficiaries must follow. For Medicare to pay for the cost of skilled nursing facilities, these rules apply:

  • You must have been officially admitted as an inpatient to a hospital for a minimum of 3 days consecutively before you get transferred to a skilled nursing facility.
  • You must enter an SNF that is endorsed by Medicare within 30 days of you leaving the hospital.
  • The service you received at the skilled nursing facility must be for the same sickness that you received treatment for at the hospital. Also, this care should be required 7 days a week.
  • In case therapy services are needed, treatment should be required at least 5 days a week.

You may originally have to go to the hospital for a particular health issue but get another condition while being admitted and may need hospital treatment. As long as you meet the 3-day qualifying period, Medicare will cover your new health condition at a skilled nursing facility, should it be required.

Talk to a Medicare Advisor

To learn more about Medicare coverage for skilled nursing care, do not hesitate to contact Cornerstone Senior Advisors to speak to an experienced Medicare expert.