Skilled nursing facility (SNF) care
Medicare Part A (Hospital Insurance) covers skilled nursing facility care for a limited time (on a short-term basis) if all of these conditions apply:
- You have Part A and have days left in your benefit period to use.
You have a qualifying inpatient hospital stay .
- Your doctor has decided that you need daily skilled care (like intravenous fluids/medications or physical therapy). You must get the care from, or under the supervision of, skilled nursing or therapy staff.
- You get these skilled services in a Medicare-certified SNF.
- You need these skilled services for a medical condition that’s either:
- A hospital-related medical condition.
- A condition that started while you were getting care in the SNF for a hospital-related medical condition.
Your costs in Original Medicare
In each benefit period , you pay:
- Days 1 - 20: $0 copayment (Note: If you're in a Medicare Advantage Plan, you may be charged copayments during the first 20 days.)
- Days 21 - 100: A $200 copayment each day
- After day 100: You pay all costs
Part A limits SNF coverage to 100 days in each benefit period.
What it is
Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and evaluate your care.
Medicare-covered services in a skilled nursing facility include, but aren't limited to:
- A semi-private room (a room you share with other patients)
- Skilled nursing care
- Physical therapy (if needed to meet your health goal)
- Occupational therapy (if needed to meet your health goal)
- Speech-language pathology services (if they're needed to meet your health goal)
- Medical social services
- Medical supplies and equipment used in the facility
- Ambulance transportation (when other transportation endangers your health) to the nearest supplier of needed services that aren’t available at the SNF
- Dietary counseling
Things to know
- You may get skilled nursing care or therapy if it’s necessary to improve or maintain your current condition. If you disagree with your discharge, you can appeal. For example, if you’re discharged only because you aren’t improving, but you still require skilled nursing or therapy care to keep your condition from getting worse, you can appeal.
- You may not need a 3-day minimum inpatient hospital stay if your doctor participates in an Accountable Care Organization (ACO), or another type of Medicare initiative approved for a Skilled Nursing Facility 3-Day Rule Waiver. If your provider participates in an ACO, check with them to find out what benefits may be available. Medicare Advantage Plans may also waive the 3-day minimum. Contact your plan for more information.