Whether you’re recovering from an injury, a planned medical procedure, or simply need extra care following a hospitalization, skilled nursing services can cover care needs during the transition between the hospital and home. If you’re on Medicare, it’s important to understand the rules and requirements around skilled nursing care coverage so you aren’t surprised by an unexpected bill.
Does Medicare Cover Skilled Nursing Services?
Yes, Medicare will pay for care at a skilled nursing facility. However, there are two requirements that must first be met:
- Your doctor must order and verify that daily skilled nursing care is needed.
- You must have recently stayed in a hospital for at least three consecutive days. During that stay, you must be listed as “admitted,” not “observational.” Your nursing facility stay must begin within 30 days of hospital discharge.
To learn about admittance classification and hospital stay requirements – and how they affect Medicare coverage – check out this blog post.
The benefit period begins on the day of hospital admission and ends when in-patient or skilled nursing care has not been received for 60 consecutive days. There is no limit to the number of benefit periods a Medicare beneficiary can have.
What Skilled Nursing Services Are Covered by Medicare?
- Medications, medical supplies, appliances and treatments provided by the nursing facility
- Rehabilitation services, including physical therapy, occupational therapy, and speech pathology
- Regular nursing services and special care units
- All meals, including medically required diets
- Semiprivate room, or private room if medically necessary
What If I Have a Medicare Supplement or Medicare Advantage Plan?
Some Medicare supplement plans may have additional guidelines or benefits for skilled nursing care. Check your plan’s summary of benefits, or contact Twin City Underwriters with questions about what is covered by your plan.
Choosing a Medicare plan can be difficult. Working with an insurance broker can help you find a plan that fits your needs. Schedule a one-on-one meeting with one of our agents to get your insurance questions answered!
This is an updated blog post that was originally published in 2018.