About Oak Lane

Skilled Nursing Facility Care

Skilled Nursing Facility Care Medicare Part A (Hospital Insurance) covers skilled nursing facility care for a limited time (on a short-term basis) if you meet all of these conditions:

*You have Part A and have days left in your benefit period to use. *You have a qualifying inpatient hospital stay.  *You enter the SNF within a short time (generally 30 days) of leaving the hospital. *Your doctor or other health care provider has decided that you need daily skilled care (like intravenous fluids/medications or physical therapy). You must get the care from, or under the supervision of, skilled nursing or therapy staff. *You get these skilled services in a Medicare-certified SNF. *You need skilled services for one of these: -An ongoing condition that was also treated during your qualifying inpatient hospital stay (even if it wasn't the reason you were admitted to the hospital).  -A new condition that started while you were getting SNF care for the ongoing condition. *You need skilled nursing care or therapy to improve or maintain your current condition, or to prevent or delay it from getting worse.

What’s a qualifying inpatient hospital stay? A qualifying inpatient 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). Medicare will only cover care you get in a SNF if you first have a “qualifying inpatient hospital stay.” What are some example situations? 

Time that you spend in a hospital as an outpatient before you're admitted doesn't count toward the 3-day qualifying inpatient hospital stay you need to get SNF benefits. How do hospital observation services affect my SNF coverage? 

You may not need a 3-day minimum inpatient hospital stay if your doctor participates in an Accountable Care Organization or another type of Medicare initiative approved for a “Skilled Nursing Facility 3-Day Rule Waiver.” Always ask your doctor or hospital staff if Medicare will cover your SNF stay. Medicare Advantage Plans may also waive the 3-day minimum. Contact your plan for more information.

If you don’t have a 3-day qualifying inpatient hospital stay and you need care after your discharge from a 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.

Your costs in Original Medicare In each benefit period, you pay: *Days 1 - 20: $0. (Note: If you're in a Medicare Advantage Plan, you may be charged copayments during the first 20 days. Check with your plan for more information.) *Days 21 - 100: $204 each day *After day 100: All costs Part A limits SNF coverage to 100 days in each benefit period.

Frequency of services: Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

What it is: Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and evaluate your care.

Medicare-covered services in a skilled nursing facility include, but aren't limited to: *A semi-private room (a room you share with other patients) *Meals *Skilled nursing care *Physical therapy (if needed to meet your health goal) *Occupational therapy (if needed to meet your health goal) *Speech-language pathology services (if they're needed to meet your health goal) *Medical social services *Medications *Medical supplies and equipment used in the facility *Ambulance transportation (when other transportation endangers your health) to the nearest supplier of needed services that aren’t available at the SNF *Dietary counseling
Things to know:
Readmission to a hospital: If you're in a SNF, there may be situations where you need to be readmitted to the hospital. If this happens, there's no guarantee that a bed will be available for you at the same SNF if you need more skilled care after your hospital stay. Ask the SNF if it will hold a bed for you if you must go back to the hospital. Also, ask if there's a cost to hold the bed for you. After you leave the SNF, if you re-enter the same or another SNF within 30 days, you don't need another 3-day qualifying hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start getting skilled care again within 30 days.

Refusing care: If you refuse your daily skilled care or therapy, you may lose your Medicare SNF coverage. If you have a condition that keeps you from getting skilled care (like if you get the flu), you may be able to continue to get Medicare coverage temporarily.

Stopping care or leaving: If you stop getting skilled care in the SNF, or leave the SNF altogether, your SNF coverage may be affected depending on how long your break in SNF care lasts. If you disagree with your discharge for any reason, you can appeal. 

If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.

If your break in skilled care lasts for at least 60 days in a row, this ends your current benefit period and renews your SNF benefits. This means that the maximum coverage available would be up to 100 days of SNF benefits."