Medicare is a Federal Program for Healthcare insurance for people that are 65 years or older or people under 65 with certain disabilities or end-stage renal disease.
Medicare A helps pay for hospital stays, skilled nursing facility care, home health care, and hospice care. In a skilled nursing facility, Medicare A covers up to 100 days of a “Benefit Period” as long as the individual has met specific criteria.
- The first 20 days are covered at 100%
- Days 21 – 100 are covered with the exception of the co-pay, which is the individual’s responsibility. The co-pay is typically covered by a supplemental insurance policy, Medicaid, or private funds.
Medicare Benefit Period
An individual qualifies for 100 days of coverage if no skilled care has been provided within the last 60 days – i.e., no acute care hospital stay or Medicare SNF (Skilled Nursing Facility) days (some hospitals have skilled beds), or skilled days used in a prior facility. If a resident has used SNF days in a hospital or another skilled facility, those days would need to be subtracted from the 100 day allotment to determine how many days the individual has remaining.
Medicare Co-Pay or Co-Insurance
This is the amount established yearly by Medicare. This is the amount per day after day 20 that Medicare does not cover and is the individual’s responsibility. Also note Medicare changes the co-insurance daily rate every year. Current rates are available at medicare.gov.
Medicare Eligibility in a Skilled Nursing Facility
- The individual must have Medicare Part A benefits and been in hospital for three consecutive (inpatient) overnights in an acute care hospital.
- The individual requires skilled nursing services or skilled rehabilitation services by a licensed professional.
- Services must be pursuant to a physician’s order stating individual requires daily skilled care.
What services does Medicare cover?
- Semi-private room
- Rehabilitation services including physical, occupational, and speech therapies
- All meals, including dietary consult and special diets
- Nursing Care
- Medical Supplies
- Special Equipment
What does Medicare not cover?
Medicare does not cover long term care or custodial care.
30 Day Window
An individual can utilize their Medicare benefit within 30 days of discharging from the hospital. For instance, if an individual decided to discharge home but realized after a few days that a better option would be to go to a skilled nursing facility to receive therapy. This option is available up to 30 days from the day the patient discharged from the hospital.
Medicare Part B
Medicare B assists in covering medically necessary doctor’s services, outpatient care, home health services, durable medical equipment, and some preventative services.
Medicare Part C (Medicare Advantage)
Medicare C includes benefits covered in Medicare Part A and Part B (Medicare’s Managed Care Program). It usually includes Medicare prescription drug coverage (Part D). Each plan offers different benefits than traditional Medicare so individuals need to choose best plan suited to meet their needs.
Medicare Part D
Medicare D is the prescription drug plan. Plans vary in cost and coverage so it is important to choose a plan that is best suited to meet an individual’s needs.
What happens when Medicare coverage ends?
If an individual would like to remain at our facility once coverage ends, our Business Office Manager, Beverly Pogue will meet with you to discuss payment options at Lincolnshire Healthcare and Rehabilitation Center.