Medicare and Skilled Nursing Facilities - What the heck is going on?

Medicare and Skilled Nursing Facilities - What the heck is going on? Medicare and health insurance in general can be confusing. Sometimes what’s covered and what’s not covered and at what rates can comes as a surprise. A common misconception is skilled nursing facility and nursing home coverage. Call us at iHealthBrokers at 888-410-0344. Our services are 100% FREE

★☆★ABOUT THIS VIDEO★☆★

0:00 Intro
1:24 Medicare & Long Term Care
2:39 Medicaid
3:22 Costs
5:20 Benefits & Criteria
6:36 Limits
7:21 Save Money


If you look at the list of benefits covered by medicare Part A on medicare.gov, you will see nursing home care and skilled nursing facility care. However, these terms are a little misleading.

Really what Medicare means by this are rehabilitative and recovery facility for after an illness or injury. These facilities must be preempted by a hospital stay and require a doctor’s approval.

Medicare does not cover any type of long term or custodial care. So a long term condition, like Alzheimers would not qualify for skilled nursing facility care covered by medicare.

Costs
If you do need skilled nursing facility care, you must first be admitted to a hospital and then received a doctor’s orders to recover in a nursing facility or home. Your stay in the nursing facility must begin within 30 days of being discharged from the hospital.
For the first 20 days, there is no cost. After that, the costs are up to $194.50 coinsurance per day. If your stay extends 100 days, you are responsible for the full costs.

You can, of course, purchase a Medicare Supplement Plan to offset or cover these costs if you so choose. Many medicare advantage plans will also cover snf.


In the SNF, you will receive rehabilitative services by professional therapists, such as physical, occupational, or speech therapists, or skilled nursing treatment that require a trained professional. Such treatments include injections, changing dressings, monitoring vital signs, or administering medicines or treatments

What Skilled Nursing Services Will Medicare Cover?

The nursing facility care and services covered by Medicare are similar to what is covered for hospital care. They include:
a semiprivate room (two to four beds per room), or a private room if medically necessary
all meals, including special, medically required diets
regular nursing services
special care units, such as coronary care
drugs, medical supplies, treatments, and appliances provided by the facility, such as casts, splints, wheelchair, and
rehabilitation services, such as physical therapy, occupational therapy, and speech pathology, provided while you are in the nursing facility.
A semi-private room (a room you share with other patients)
Meals
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
Medications
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


What Will Medicare Not Cover?
Medicare coverage for a skilled nursing facility does not include:
personal convenience items such as television, radio, or telephone
private duty nurses, or
a private room when not medically necessary.

Long Term Care
If you are in a nursing facility only because you are unable to feed, clothe, bathe, or move yourself, even though these restrictions are the result of your medical condition, you are not eligible for Medicare Part A coverage. This is because you do not require skilled nursing care as defined by Medicare rules. However, if you require occasional part-time nursing care, you may be eligible for home health care coverage. Also, if your condition is long term, you can look into long term care plans.


If you have any further questions, please feel free to contact us here at iHealthBrokers at 888-410-0344 or https://ihealthbrokers.com/


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