Medicare and Your 100 days!
When patients are admitted to a skilled nursing facility (SNF) they are often under the assumption that traditional Medicare will automatically pay for 100 days of care. While Medicare beneficiaries do have up to 100 days of skilled nursing benefits, there are criteria that must be met in order to utilize this benefit.
Who is eligible for Medicare?
- Anyone with Medicare Part A with days remaining in their benefit period.
- A patient must have a minimum stay of at least 3 consecutive midnights in a hospital. This does not count an observation period. An inpatient stay begins on the day you are admitted to a hospital.
- The patient requires daily skilled care given by skilled nursing or therapy staff.
Skilled nursing and/or skilled rehabilitation services are those services, furnished pursuant to physician orders, that:
- Require the skills of qualified technical or professional health personnel such as registered nurses, licensed practical (vocational) nurses, physical therapists, occupational therapists, and speech-language pathologists or audiologists; and
- Must be provided directly by or under the general supervision of these skilled nursing or skilled rehabilitation personnel to assure the safety of the patient and to achieve the medically desired result.
Medicare covered services in a SNF include, but are not limited to:
- Room rate
- Skilled nursing care
- Physical, occupational, and speech-language services (if needed to meet your health goals)
- Social services
- Medical supplies and equipment used in the facility
- Dietary services
Your costs associated with a Medicare skilled nursing stay:
- Days 1 – 20: $0 for each benefit period
- Days 21 – 100: For calendar year 2017, the co-pay is $164.50 per day. Many people have a supplemental insurance plan that will cover some, if not all, of the co-pay.
- Days 100+: You are typically responsible for all costs.
What if your Medicare coverage stops or you are discharged from the facility prior to using all 100 days?
This depends on how long your break in SNF care lasts.
Less than 30 days: You don’t need a new 3-day inpatient hospital stay to qualify for coverage, but you do need to meet all other coverage requirements. Your current benefit period would continue where it left off when you were discharged from the facility. The maximum coverage is still 100 days.
At least 30 but less than 60 days: Medicare won’t cover additional SNF care unless you have a new 3-day qualifying inpatient hospital stay, and you meet all other coverage requirements. The reason for the new hospital stay does not have to be the same as the previous stay. Since the break in your SNF stay was less than 60 days your current benefit period would continue.
At least 60 days: Medicare won’t cover additional SNF care unless you have a new 3-day qualifying hospital stay, and all other coverage requirements are met. Since your break in skilled care lasted for at least 60 days in a row, this would end your current benefit period. This means that the maximum coverage available would be up to 100 days of SNF benefits in your new benefit period.
Medicare uses a period of time called a benefit period to keep track of how many days of SNF benefits you use, and how many are still available. A benefit period begins on the day you start getting inpatient hospital or SNF care. You can get up to 100 days of SNF coverage in a benefit period. Once you use those 100 days, your current benefit period must end before you can renew your SNF benefits.
There’s no limit to the number of benefit periods you can have. However, once a benefit period ends, you must have another 3-day qualifying hospital stay and meet the Medicare requirements before you can get up to another 100 days of SNF benefits.
Clear as mud? If you have more questions about Medicare, you have several resources available to you. You can go online to medicare.gov or contact the the Senior Health Insurance Benefits Advisors (SHIBA) at 800-247-4422, or go online to SHIBA at shiba.idaho.gov
As a skilled nursing facility (SNF) we deal with Medicare on a daily basis and can easily and promptly answer your questions. Just give us a call at 208-798-8500. We are here to help!
by Tiffany Goin, Executive Director, Life Care of Lewiston
Tiffany Goin is a licensed nursing home administrator with over 13 years experience in long term care. She is currently the Executive Director at Life Care Center of Lewiston. Tiffany resides in Clarkston, WA with her husband, Darrin, and daughter, Macie.