Are you wondering if Medicare covers Skilled Nursing Facility (SNF) care? The short answer is yes—but certain conditions and limits apply. Understanding these requirements is crucial for accessing Medicare benefits effectively.

This guide explains Medicare’s coverage for SNF care, eligibility criteria, covered services, and associated costs. By the end, you’ll have a clear understanding of how Medicare can assist with your skilled nursing needs.

What is a Skilled Nursing Facility (SNF)?

A Skilled Nursing Facility provides specialized medical care focused on short-term rehabilitation. Staffed by healthcare professionals such as nurses and therapists, SNFs help individuals recover after hospital stays, surgeries, illnesses, or injuries.

Common services provided at SNFs include:

• Skilled nursing care
• Physical, occupational, and speech therapy
• Assistance with daily living activities
• Medical social services

Medicare Coverage for Skilled Nursing: Eligibility Requirements

To qualify for Medicare-covered SNF care, you must meet specific conditions:

1. Hospital Stay Requirement

You must first have an inpatient hospital stay related to your medical condition.

2. Minimum Duration of Hospital Stay

Your hospital admission must be for at least three consecutive days.

3. Inpatient Status Requirement

The hospital stay must be classified as an inpatient admission, not an “observation” stay.

4. Doctor’s Prescription for SNF Care

Your healthcare provider must prescribe ongoing skilled nursing care upon hospital discharge.

5. Therapy Frequency Requirement

Therapy services, if required, must occur at least five days per week.

6. Coverage for Additional Health Conditions

Medicare covers additional conditions or complications arising during your SNF stay.

What Services Does Medicare Cover in a Skilled Nursing Facility?

Medicare provides coverage for:

• Semi-private room
• Meals
• Skilled nursing care
• Physical, occupational, and speech therapy
• Medical social services
• Medications administered in the facility
• Medical supplies and equipment used within the facility
• Ambulance transportation for necessary services
• Dietary counseling

Medicare does NOT cover:

• Telephone or television charges
• Private-duty nursing
• Personal items (e.g., razors, toothpaste)

How Long Does Medicare Cover Skilled Nursing Facility Care?

Medicare provides SNF coverage based on “benefit periods,” each lasting up to 100 days:

• Days 1–20: Medicare covers 100% of SNF costs.
• Days 21–100: You’re responsible for a daily coinsurance fee (approximately $200/day).
• After Day 100: Medicare coverage ends, and you’re responsible for all costs.

A new benefit period starts after 60 consecutive days without SNF or hospital care. There’s no limit on how many benefit periods you can have.

Costs Associated with Skilled Nursing Care

Here’s a summary of SNF care costs:

• Days 1–20: $0 (fully covered)
• Days 21–100: Coinsurance (~$200 per day)
• Days 101 and beyond: All costs paid out-of-pocket

Additional costs for private rooms, personal items, or non-medically necessary services are not covered by Medicare.

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Frequently Asked Questions (FAQs)

Does Medicare Advantage Cover SNF?
Yes, most Medicare Advantage plans cover SNF care, but rules and costs vary by plan.

Do Medigap Plans Cover SNF?
Yes, most Medigap plans cover SNF coinsurance costs for up to 100 days.

What’s the Difference Between Custodial and Skilled Nursing Care?
Custodial care helps with daily tasks like dressing or bathing, while skilled nursing involves medical care by licensed professionals.

What is a Qualified Inpatient Hospital Stay?
It’s an inpatient hospital stay lasting at least three consecutive days required for Medicare SNF coverage eligibility.