Medicare Part A Benefits:
The terms skilled nursing facility, nursing homes, SNFs, and rehab center are
used interchangeably.
To use Medicare part A benefits in a skilled nursing facility (SNF), nursing
home, or rehab facility, the resident must have had a three day hospital stay.
On the fourth can they can be transferred from the hospital to a rehab center -
nursing home. Medicare will
pay for their limited stay if the resident is receiving therapy or an approved
skilled service by nursing which can be oxygen, trach, IV antibiotics, or wound
care. The most common way is for the resident to receive physical therapy,
occupational therapy, or speech language pathology.
The resident can have up to 100 Medicare days to use. This will pay
their room rate, medications, nursing care, therapy (rehab), and meals.
Usually when the resident stops having therapy or refuses therapy 3 days in a
row, Medicare will stop paying.
Medicare A will pay 100% for the first 20 days, for days 21-100 they will pay
everything except $99.00 a day. This is where a secondary insurance is
helpful. Make sure the admissions director at the rehab center / nursing
home calls to verify the
Medicare A days and any secondary insurance to let you know if there will be
anything owed after the 20th day.
If the resident gets re-admitted back to the hospital, the days they are in
the hospital will not be subtracted from the original 100 days.
If the resident has gone straight home from the hospital and they
require more care than the family can provide, if the resident qualifies from
the above criteria, they have 30 days to go to a rehab center / nursing home to get therapy or skilled
nursing care. Medicare A benefits will still pay for their rehabilitation
/ nursing home stay.
If the resident uses up all of their 100 days and goes home, if they return
to the hospital before 60 days are up, Medicare A will not pay for a new rehab /
nursing home
stay. If 60 days have passed and they have a new diagnosis, then Medicare
A will pay for a new rehab / nursing home stay.
If the resident only uses some of their 100 days and gets discharged home
from the rehab center / nursing home, the resident will have to have another 3 day hospital stay if they
want to go back to the rehab center / nursing home. If the rehab / nursing
home stay was within 60 days, the
Medicare A days will continue from where they left off from the last SNF
stay. If the SNF stay wasn't within a 60 day period, the 100 days will
start over if the resident has a new diagnosis.
When your family member is in the hospital and you know which SNF- rehab
center - nursing home you would
like to take your loved one too, the admissions director at the SNF should know
all of these rules and can call Medicare A for you and find out exactly how many
days the resident has.
