Original Medicare (Parts A & B): Skilled Nursing Facility (SNF) Care

Covers short-term, Medicare-certified SNF care for those who have benefit period days remaining and a qualifying inpatient hospital stay.

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Cost
$0 for Days 1 - 20; Up to $200 coinsurance each day for Days 21-100; with additional costs below.
Prior Authorization Required
No, but a Medicare-certified SNF is required
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

Have at least a 3-day qualifying hospital stay and obtain a provider order for admission to a Medicare-certified SNF care following hospital discharge.


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For more information on Medicare benefits and coverage, call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Benefits Website. TTY users, call 1-877-486-2048.

Additional Information on Costs

  • $0 for Days 1 - 20;

  • Up to $200 coinsurance each day for Days 21-100;

  • All costs for each day on Day 101 and beyond

Availability
Ongoing, per benefit period
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What it is

Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, licensed professionals or technical personnel. It comprises skilled nursing and/or skilled therapy to treat, manage, and observe and evaluate care.

Medicare-covered services in a skilled nursing facility include, but aren't limited to:

Things to know

While Medicare covers SNF care, there are some situations that may impact coverage and costs.

Observation services. The provider may order observation services to help decide whether admission to the hospital as an inpatient is needed or whether your loved one can be discharged. During the time they are getting observation services in the hospital, they are considered an outpatient and this time cannot be counted towards the 3-day inpatient hospital stay required for Medicare to cover an SNF stay.

Readmission to the hospital. If your loved one is in a SNF, there may be situations where they need to be readmitted to the hospital. If this happens, there's no guarantee that a bed will be available for at the same SNF if more skilled care is needed after the hospital stay. TIP: Ask the SNF if it will hold the bed in the case of readmission to the hospital. Also, ask if there's a cost to hold the bed.

Meeting the 3-day inpatient hospital stay requirement. Here are some examples of common hospital situations that show if the 3-day inpatient hospital stay requirement has been met:

Refusing care. If your loved one refuses daily skilled care or therapy, they may lose their Medicare SNF coverage. If their condition won't allow them to get skilled care (say, they get the flu), they may be able to continue to get Medicare coverage temporarily.

Stopping care or leaving. If your loved one stops getting skilled care in the SNF, or leaves the SNF altogether, the SNF coverage may be affected depending on how long the break in SNF care lasts.

If the break in skilled care lasts more than 30 days, they will 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 they were treated for during their previous stay.

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

Costs

For each benefit period*, your loved one is responsible to pay:

There is a 100-day limit on Part A SNF coverage in each benefit period.

*BENEFIT PERIOD: There is no limit to the number of benefit periods. A "benefit period" starts the day of admission to a hospital or skilled nursing facility. It ends after 60 days in a row without hospital or skilled nursing care. Upon hospital admission after one benefit period has ended, a new benefit period begins.

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