When does Medicare coverage of skilled nursing facility care begin?
This is the official U.S. government booklet about Medicare Coverage of Skilled Nursing Facility Care benefits for people with Original Medicare. This booklet has important information about the following:
How would my hospital status affect the way Medicare covers my care in a skilled nursing facility (SNF)?
Medicare will only cover care you get in a SNF if you first have a “qualifying hospital stay.”
• A qualifying hospital stay means you’ve been a hospital inpatient for at least 3 days in a row (counting the day you were admitted as an inpatient, but not counting the day of your discharge).
• If you don’t have a 3-day inpatient hospital stay and you need care after your discharge from the hospital, ask if you can get care in other settings (like home health care) or if any other programs (like Medicaid or Veterans’ benefits) can cover your SNF care. Always ask your doctor or hospital staff if Medicare will cover your SNF stay.
How would hospital observation services affect my SNF coverage?
Your doctor may order “observation services” to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you’re getting observation services in the hospital, you’re considered an outpatient. This means you can’t count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay.
People with Medicare are covered if they meet all of these conditions:
You have Part A and have days left in your benefit period. You have a qualifying hospital stay. Your doctor has decided that you need daily skilled care given by, or under the direct supervision of, skilled nursing or rehabilitation staff. If you’re in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week, as long as you need and get the therapy services each day they’re offered. You get these skilled services in a SNF that’s certified by Medicare. You need these skilled services for a medical condition that was either: A hospital-related medical condition. A condition that started while you were getting care in the skilled nursing facility for a hospital-related medical condition. Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you’re getting observation services in the hospital, you’re considered an outpatient—you can’t count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay. Find out if you’re an inpatient or an outpatient.
Note: If you refuse your daily skilled care or therapy, you may lose your Medicare SNF coverage. If your condition won’t allow you to get skilled care (for instance if you get the flu), you may be able to continue to get Medicare coverage temporarily.
Your costs in Original Medicare You pay:
Days 1–20: $0 for each benefit period .
Days 21–100: $164.50 coinsurance per day of each benefit period.
Days 101 and beyond: all costs.
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