Medicare Coverage of Care in a Nursing Facility - dummies

Medicare Coverage of Care in a Nursing Facility

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Medicare Part A covers certain specialized services outside the hospital, most of which focus on nursing. Care in a skilled nursing facility is one type of care that can be covered by Medicare.

Say you’ve been in the hospital and are now being discharged but still need more-specialized nursing care than you can receive at home — for example, physical therapy to help you walk again after a hip replacement, speech therapy after a stroke, a continuing need for intravenous fluids, or wound care.

Medicare covers this type of ongoing care under Part A, usually at what’s called a skilled nursing facility — most often a nursing home — under certain conditions.

The most important condition for Medicare coverage of care in a skilled nursing facility is that you must have been in the hospital as a formally admitted patient for at least three days. A doctor must order the services that you need from professionals such as registered nurses and qualified physical therapists and speech or hearing pathologists. And the skilled nursing facility you go to must be one that Medicare has approved.

Traditional Medicare covers stays in a skilled nursing facility for up to 100 days in a benefit period. The first 20 days cost you nothing; from day 21 through day 100, you pay a daily co-pay, which goes up slightly every year. (In 2013, the co-pay is $148 a day.)

Some Medigap supplemental insurance policies cover these co-pays 100 percent. If you’re enrolled in a Medicare Advantage health plan, look at your coverage documents or call your plan to find out what it charges for stays in skilled nursing facilities.