19 January Skilled Nursing Facilities and the Costs Medicare Won't Cover January 19, 2017 By Editor Medicare Supplement medicare, medicare supplement, medigap, seniors 0 One of the benefits Medicare provides is coverage for a Skilled Nursing Facility. Many people are under the false impression that Medicare covers all of the costs associated with a Skilled Nursing Facility up to a stay of 100 days; however, this is not true. In fact, Medicare only covers all of the costs from Day 1 to Day 20. From the 21st day of your stay to the 100th day, you must pay $164.50 in coinsurance each day. If you were to stay in a SNF for 100 days, you would pay a total of $13,160 out-of-pocket in coinsurance. From Day 101 on, you must cover all costs accumulated at the SNF without any help from Medicare. Your Skilled Nursing Costs with Original Medicare: Day 1-20: $0 Days 21-100: $164.50 coinsurance per day Days 101+: all costs Skilled Nursing Facilities To help better understand these costs, let’s first look at what defines a Skilled Nursing Facility. A Skilled Nursing Facility is much like a nursing home; however, they provide much more skilled medical expertise and services. They provide nursing care as well as rehabilitative services for those who are injured, sick, or disabled to help in getting patients back on their feet. Here is a list of services offered by Skilled Nursing Facilities from www.skillednursingfacilities.org: Stroke Recovery – rehabilitation therapy, helping patients regain motor skills and speech functions. Parkinson’s Care – specific care required to attend advanced Parkinson’s cases (does not apply to all facilities) Custodial Care – helps patients with needs like bathing, dressing, and eating. General Wound Care – cleans wounds and administers antibiotics for infection. Acute Medical Conditions – services offered to help cases where an illness, infection, or injury threatens the patient’s health. Terminal Illness Care – services offered along with hospice care for people living with terminal illness and require custodial care and medical care. General Rehabilitation – speech, physical, and occupational therapy and other services to help patients recover after an extended illness or invasive operation. Medicare Qualifications Please note that Medicare only pays for skilled nursing when the patient has a qualifying inpatient hospital stay of 3 days, the doctor decides you need daily skilled care, and the SNF chosen is certified by Medicare. If all of these conditions are not met, Medicare will not cover any costs accumulated at the SNF. Medicare Supplement (Medigap) Coverage of Skilled Nursing Facilities To keep you from having to pay the high coinsurance payments out-of-pocket, certain Medicare Supplement, or Medigap, policies cover the coinsurance or copayments that come along with Skilled Nursing Facilities. Medigap Plans C, D, F, G, M, and N all cover 100% of the coinsurance or copayments accumulated while in a Skilled Nursing Facility. Medigap Plan K covers 50% of SNF copayments, and Plan L covers 75% of SNF copayments. When a patient needs 24/7 intensive care, a Skilled Nursing Facility provides the expertise and services needed to ensure the patient receives the care they require. Although Medicare covers some of the costs brought along by Skilled Nursing Facilities, the high copayments can add up quickly, leaving the patient to pay them out-of-pocket in a time of need. The security of a Medigap plan during a stay at a Skilled Nursing Facility allows the patient to receive the care they need free of cost and free of worry. Visit ManhattanLife's Medicare Supplement for plan information. Related Posts A Few Things Medicare Won't Cover, and How to Pay for Them Medicare does not cover for things like dental, glasses and hearing aids, and long term care. We detail each category and explain how to pay for them. How Much Can a Medigap Plan Save You When Medical Bills Stack Up? We Did the Math. A Medicare Supplement plan, also called a Medigap plan, is designed to cover the healthcare costs that Medicare won't. In order to show how important a Medigap plan can be in protecting you from out-of-pocket costs, we calculated how much money a Medigap plan would save you in the event of an unlikely, yet completely possible, serious medical issue. Unpacking Medicare Supplement: Part 1 Along with Medicare, Medicare Supplement or Medigap can give assist in providing more thorough health insurance. Join Maggie as she embarks on a five-part journey to better understand just how beneficial Medicare Supplement coverage can be. Unpacking Medicare Supplement: Part 2 Maggie continues her quest to learn more about healthcare at age 65 and beyond. In Part 2 of our blog series, she discovers the myriad of details that make up this supplemental insurance. Unpacking Medicare Supplement: Part 4 Medigap Maggie's learning journey reaches its end and epilogue. Here, further details and potential scenarios are given, and questions are answered. Unpacking Medicare Supplement: Part 3 After much studying and contemplation, Maggie takes the necessary steps to acquire a Medicare Supplement policy. Comments are closed.