Financial / Rates

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When will Medicare cover skilled care?

Medicare will cover skilled care only if all of the following are true:

  • Your doctor has ordered the services you need for SNF care, which require the skills of professional personnel such as registered nurses, licensed practical nurses, physical therpists, occupational therapists, speech-language pathologists, and are furnished by, or under the supervision of, these skilled personnel.
  • You require the skilled care on a daily basis and the services must be ones that, as a practical matter, can only be provided in a SNF on an inpatient basis
  • The skilled services must be reasonable and necessary for the diagnosis or treatment of your condition

What is skilled care?

Skilled care is health care given when you need skilled nursing or rehabilitation staff to treat, manage, observe and evaluate your care.

  • Examples of skilled care include intravenous injections and physical therapy
  • Care that can be given by non-professional staff isn’t considered skilled care
  • People don’t usually stay in a SNF until they are completely recovered
  • Medicare covers certain skilled care services that are needed daily on a short-term basis (up to 100 days)
  • Skilled care requires the involvement of skilled nursing or rehabilitative staff in order to be given safely and effectively

Skilled nursing and rehabilitation staff includes:

  • Registered nurses
  • Licensed practical and vocational nurses
  • Physical and occupational therapists
  • Speech-language pathologists

What is an Assessment?

Your assessment determines how much Medicare pays the SNF, based on the services and resources you need. When you go to a SNF, a team of staff from different medical fields (depending on your health needs) plans your care.

What is a care plan?

Your care plan may include what kind of services you need, what type of health care professional should give you the services, how often you will need the services, what kind of equipment or supplies you need (like a wheelchair or feeding tube), if you need a special diet, and your health goal (or goals), and how your care plan will help you reach your goal.

What do I pay for Skilled Nursing Facility (SNF)?

Residents must have a Medicare card that reads “Hospital Insurance.” They must also be admitted to the facility with a physician order within 30 days of a three consecutive night hospital stay. Generally, during the first 20 days of care, Medicare will pay 100%. For days 21-100, a daily co-insurance rate is required. Medicare does not cover Part A skilled nursing fees over 100 days.

Ways to get help paying for skilled care and other health costs:

Help from your state: If your income and resources are limited, you may be able to get help to pay for skilled and/or custodial care, or other health care costs. If you qualify for both Medicare and Medicaid, most health care costs are covered.

Employer or Union coverage: If you have coverage from an employer or union, check with your benefits administrator to see what health care is covered.

MediGap Policy: If you are on the Original Medicare Plan, you may have a MediGap policy to fill gaps in your coverage.

Long-Term Care Insurance: If you have long-term care insurance, check your policy or call the insurance company to find out if skilled or custodial care is covered. If you are shopping for long-term care insurance, find out which types of long-term care services the different policies cover.

Our business office staff is available to assist our residents in obtaining insurance information and eligibility for the many services offered by our facility. Our facility does accept Medicare and Medi-Cal insurance. We happily bill secondary and third party insurance carriers, with prior authorization, in an effort to reduce out of pocket expenses. If you need assistance with payment for services provided, please contact our Office Manager for detailed information.