Understanding the Medicare Skilled Nursing Benefit

Sunrise Senior Living  |  March 21, 2019
Understanding the Medicare Skilled Nursing Benefit
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Seniors and their families often find the Part A section of the Medicare benefit especially confusing, and for good reason. Medicare Part A covers a wide range of care, including hospital stays, skilled home health care, lab tests, hospice, and skilled nursing and rehabilitation centers. Each one has different coverages and deductibles.

As older adults continue to live longer, more active lives, many find themselves needing a hip or knee replacement. Others need rehabilitation to get back on their feet after a serious bout of the flu. It’s a good idea to learn more about the Medicare Part A skilled nursing and rehabilitation benefit before you or your senior loved one needs to utilize it.

Medicare and Short-Term Rehab Center Coverage

If a Medicare recipient spends three nights in the hospital at an inpatient level of care and their physician orders a transfer to a skilled nursing and rehab center, their coverage will typically be as follows:

  • Days 1 through 20 are usually 100 percent covered.
  • From day 21 through day 100, if the older adult continues to meet the clinical requirements for a rehabilitation stay, they will be responsible for daily coinsurance of $170.50.
  • After day 100, the senior is responsible for the full amount of their rehab center stay.

One additional factor to consider relates to secondary health insurance. If an older adult has secondary insurance, it may cover part or all of the coinsurance costs.

What Services Are Covered by Medicare

If you or your senior loved one is transferred to a short-term rehab center, Medicare usually pays for:

  • semi-private room
  • all meals and snacks
  • physical, occupational, and speech therapy
  • skilled nursing care and personal care assistance
  • medications ordered by a physician
  • medical supplies and adaptive equipment.

Services and amenities like phone service, television, laundry, and beauty/barber shop services may have additional fees.

Medicare 30-Day Window

Be aware of what is referred to as the Medicare 30-day rule. If a senior is discharged from a hospital or rehab center and things don’t go as well as planned, they can be admitted or readmitted to a short-term rehab center if no more than 30 days have passed.

If the older adult meets the criteria for rehab and has spent three consecutive nights in the hospital in the last 30 days, they can be readmitted to a rehab center to continue their therapy. This often gives seniors peace of mind at the time of discharge.

Respite Care for a Smooth Transition Home

Another option for older adults and their families to consider is respite care. These short-term stays at senior living communities allow a senior to stay in a supportive environment until they get back on their feet. It can be a viable solution for a senior who hasn’t met the three-night hospital stay requirement or for those who run out of covered days before they are ready to return home.

Call Sunrise to learn more about respite care options near you or your senior loved one today!