Qualifying for Medicare Coverage in a Skilled Nursing and Rehabilitation Center?
- Beneficiary must have a three day qualifying hospital stay.
- Admitted to the healthcare center within 30 days of a hospital discharge.
- Have unused Medicare Part A days.
- Have a diagnosis covered by Medicare.
Medicare Coverage in a Skilled Nursing and Rehabilitation Center?
must receive the services from a Medicare certified skilled nursing
facility. You are given 100 days of Medicare Part A coverage during a
benefit period. The day you start receiving hospital or skilled nursing
facility benefits is considered the first day of your benefit period.
The first 20 Medicare days are paid 100% by Medicare Part A. Medicare
will pay for all Medicare related charges during the last 80 days of
your benefit period except for the co-insurance amount.
It is also
important to note that you are not limited to a certain number of
benefit periods, but you will need to have another three day hospital
stay and continue to meet Medicare requirements in order to receive
another 100 day Medicare benefit period.
Will I Remain on Medicare Part A for the Full 100 Days?
patient will remain on Medicare, Part A as long as it is medically
necessary. If at any point during the patients stay their health
improves and their diagnosis no longer supports Medicare coverage, they
will either be discharged or change payor types.
How Do I Qualify for a New 100 Days of Coverage?
beneficiary must go 60 consecutive days without receiving skilled care.
After the sixty day period, the beneficiary qualifies for another 100
days of care if they meet the pre-mentioned criteria.
What is Co-insurance?
is also referred to as percentage participation. When your initial 20
days are up under Medicare, your co-insurance will help you to pay for
the services you are receiving that are not being covered through
Medicare. There are typically three sources of co-insurance:
- Private Insurance Company
- The Patient
The patient is ultimately responsible for payment of co-insurance.
What Services Does Medicare Part B Pay for?
Part B pays for the following services when the patient is no longer covered by Medicare Part A:
- Physical Therapy
- Speech Therapy
- Occupational Therapy
Medicare Part B covers a number of medical services not covered by Part
A, if they are medically necessary. There is a 20% co-insurance amount
for which Medicare Part B does not pay.