Medicare Coverage of Skilled Nursing-Facility and Rehabilitation-Facility Care


nursing_home

What It Is

Inpatient care in a skilled nursing facility (SNF) or acute rehabilitation care in an inpatient rehabilitation facility (IRF)

What's Covered

There are two different types of inpatient nursing and rehabilitation care that Medicare Part A covers, each under a different set of rules and limitations.

1. Skilled nursing facility (SNF)

Medicare Part A covers inpatient care in a skilled nursing facility under the following circumstances:

  • A patient's stay must begin within 30 days of an inpatient hospital stay of at least three days.

  • The patient must need, and have a physician's prescription for, daily skilled nursing care or physical rehabilitation.

  • Care must be in a Medicare-certified skilled nursing or rehabilitation facility.

  • Coverage lasts only while the patient's condition is improving. Once the patient's condition has stabilized, Medicare Part A will no longer cover inpatient care.

2. Inpatient rehabilitation facility (IRF)

Medicare Part A covers acute rehabilitation care in an inpatient rehabilitation facility under the following circumstances:

  • The patient must need, and a physician must prescribe, acute rehabilitation consisting of at least two different types of therapy (such as physical and speech therapy, or physical and occupational therapy).

  • The patient must need, and a physician must prescribe, at least three hours per day of rehabilitation therapy.

  • The patient must need to receive the care as an inpatient, as prescribed by a physician and justified by the facility on an ongoing basis.

  • Care must be in a Medicare-certified inpatient rehabilitation facility.

  • Coverage lasts only as long as the patient needs the qualifying level of care.

Note: There's no requirement of a prior hospital stay in order to receive IRF coverage, but without prior hospitalization, Medicare is more likely to question the need for inpatient rehabilitation care (as opposed to receiving the care as an outpatient).

Warning: Medicare *doesn't* cover long-term nursing home residence, or a stay of any length in a nursing facility for custodial care, or any level of care that doesn't meet all of the above-described conditions under one or the other type of covered care.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for inpatient care in a nursing or rehabilitation facility, contact the plan directly.

What Medicare Pays

1. Skilled nursing facility (SNF)

For the first 20 days of coverage during any benefit period, Medicare Part A pays the full Medicare-approved amount for the cost of a SNF stay. (A benefit period is the period during which someone is a hospital inpatient, plus the following period in a Medicare-covered skilled nursing or rehabilitation facility. A benefit period begins on the first day in the hospital and continues until the patient has been out of the hospital and any other Medicare-covered nursing or rehabilitation facility for 60 consecutive days.)

For days 21 to 100 of a covered stay in a skilled nursing facility during any one benefit period, Medicare pays the full Medicare-approved amount, except for a daily coinsurance amount of $141.50 per day.

After 100 days in a skilled nursing facility in any one benefit period, Medicare no longer pays any of the cost.

2. Inpatient rehabilitation facility (IRF)

Medicare Part A pays 100 percent of the Medicare-approved amount for a stay in an IRF for as long as Medicare agrees that such inpatient care is medically necessary.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

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26 Comments So Far. Add Your Wisdom.

1 day ago

A nursing home can NOT ask for out of pocket pay from the patient if their stay was 20 days or less. Tell them to take that up with Medicare. This is a scam. I would contact Medicare and inform them that I am being asked for money from the nursing home. PAY THEM NOTHING!


about 1 month ago

My gpa is recently diagnosed with dementia. He has had falls after taking off out in the snow. And has been hospitalized for those times. Medicare will not pay for nursing home he owns four properties which he has let delapidate. Almost to point of being condemned. So he is not able to sell. Now he has been refusing to bathe and senior services has been out telling us we have to put him in a nursing home that if we dont they are gonna take all his properties and any assests he has n force him into a home n control his money. They are telling us we have no right to hire homehealth care. If we try they will take him and his properties aeay putting ten people out on the streets including infants. Does senior services have that right? Just to come in to a persons life who is not being abused n take everything.??


4 months ago

My mom was recently diagnosed with aml and also delirium. She was in the hospital for 3 weeks 2 days and then sent to a nursing home for rehab . Due to the delirium she is having difficulty with the therapy and because she is not progressing Medicare will not pay for her stay . Medicaid is not an option for us because my parents own 3pieces ofproperty .she is eligible for hospice home care but she requires around the clock care and if they could provide assistance for 5hours a day I would have to take care of her by myself for 19hrs a day I have a 3yr old and a 6yr old and this would be to difficult for me alone and I have no one to help me my dad is 79 and is in poor health and is still trying to work topay for her insurance is there any special places that take people who have a low income or is there any charities that can help us?


4 months ago

Hello MiriamEtiennĀ­e, I am sorry to hear of the challenges you are currently facing.If you haven't already, you may want to contact your local Area Agency on the Aging for assistance. To find your local Area on the Aging you can go to this link: http://www.caring.com/local/area-agency-on-aging Also, Caring.com's Family Advisors may also be of assistance to you. They can be reached at 866-824-8174.


4 months ago

I need HELP !!! MY 88 year old mother has been able to fend for herself and the help of a kind neighbor in NYC until this last July 30 when I was away in New Orleans, La she put her head through a bank door that was closed but so clean and polished she thoght it was open. Since that time she has been in and out of Saint Luke Hospital in NYC and I was given an ultimatum : "Either you tkae your mother who has been found to have "Dementia "or she will b eplace in a State run facility in the Bronx and the state will become her Guardian until she passes away. I consult my only daughter and I am an only child myself so what are my chances to be able to provide a place for my mom in New Jersey where I live when now after having her here with me for almost two months already she behaves in a very erratic way and will not leave a drawer ot a closet alone, will tear and ruin all my clothes and hides food under the bed that I provided for her that used to be my very nice "Guest Room "and now looks like a hurricaine went through it. I have to still transfer her Medical Papers here to Bergen County to het her registered here. My questiopn is if she has any assets that she might have hidden away for which I have hired an Attorney and now have POA and if there is any money that would go to my 38 year old dauther who works and has Terminal Cancer in all her Vital organs and still she works and refuses any kind of Government help which mekes me feel that my only daughter is a hard worker who wants to carry her own weight even when she is hurting and is in pain because of the Chemo Medicine she is given in oder to survive, I need to know what I shall do with my mother, she is getting my Chronic Fatigue much worst tot he point that even today I had a very hard time getting up form the couch in my liivng room Why do I sleep in my living room ? GOOD QUESTION that I want others to know, my mother might have DEMENTIA but she is BRILLIANT when it comes to pass unnoticed and while I was sleeping on my room in the back of my apartment past the k,itchen and bathroom, my mother walked downstairs and into the streets and walked three and a half long blocks away from my house. I was lucky that a nice neighbor caught her in time before she went off to far into another next town and then God only knows what might have happenend to her. I can not put her in the read bedroom because the kitchen is next to that rear bedroom and the gas stove is there so I let her stay in the Guest Room next to my lving room, I had closed the door that used to connect the two bedorroms to give my Master Bedroom more space as spac ein this house is limited, I gained more space by putting a wall in the Guest Room so the only way out is through the Living Room and while she is here I sleep in the couch in the liivng room next to my computer desk and I place the computer chair ina way that if she tries to pass I can feel it and hear it as I have a Bamboo Center Table across the couch and mom has no cloice but to pass next to th ecouch where I am sleeping. I am her only child and her only brother has passed away a couple of months ago and that has made her even worst as now she sees herself more dependant on others and unable to go and come as she places. I called an 89 year old neighbor to hear what she had to say about "Nursing Home Placement "and she made a very good point fo rme. The old neighbor is a very savvy lady and she said that I shall find out if I put her in a Passaic Nursing Home that I had already check if the fact that Passaic is another County then I might have to worry that my County of Bergen will not be able to help me for any help I might have concerning her. I have a sore throat because I had to take my mom with me to the bank to get her signature for a Debit Card to get what she needs, so far th eproblem is that she still holds a plac ein NYC she has full of stuff that grabs all the money she gets from Social Security, I have already got Power of Attorney and I am looking very carefully through all her old papers but so far she has been able to hide everything well and the joke is on me that I have to buy her stuff with my own money because there is not much money left in her checking account after the rent money and the phone payment get taken out uatomatically from it. So how do I deal with trying to get her residence to the State of New Jersey to Bergen county where my house is ? I need help with what are the correct steps to take when after asking several lawyers all they seem to want to talk is about FEES FOR EVEN FIRST CONSULTATION FOR ELDER LAW AFFAIRS ! Is there any organization I can call in NJ that can help me with this ? Thank you so very much, Miriam


5 months ago

I wouldike to know how to get my sister out of a nursing/rehab facility which is causing more damage to her physically and mentally.? My sister is not getting the rehab for walking she is supposed to be getting. Instead she has gotten a fracured right and more depressed. How can the family get her out. She is being physically and emotional abused.


5 months ago

My Mother is on Medicare and has a supplemental insurance policy ; she has been in rehab at a Nursing Home for 45 days after being discharged from a 7 day hospital stay. She has been taken back to the hospital and will probably be there for 4-5 days. Will she qualify for an additional 100 day stay in the nursing home or will she just have the remaining 55 days from her previous stay?


Anonymous said 5 months ago

My dad fell down 4 stairs onto a concrete driveway. Cat scan was ok but he sustained a knee injury which turned out to be a torn ACL . He is 87 and doctor says he needs to have hospital stay of 3 days to be able to be admitted to a rehab facility. He can not get out of his chair on his own and can not walk to get to the bathroom . Is there a way to get my father admitted to a rehab facility without the required 3 day hospital stay that will be able to be covered by Medicare ? Without the proper rehab he will not be able to function at home because he has no mobility because of the injury.


6 months ago

My husband went to a skilled facility two days ago with horizon insurance from the hospital.. Medicare starts on nov 1 the facility says he has to leave on nov 1 because he does not have a qualifying hospital stay. Is this true?


8 months ago

My dad just returned to my home after a 6 day stay in the hospital for a hematoma on his kidney. He is in severe stage of Alzheimer's and falls. We have a walker. Last night he tried to get into the bathroom b himself and fell. I want to know if anyone has any suggestions of What to do so I can hear him at night other than sleeping in same room.


11 months ago

Medicare just issued a clarification that the patient no longer has to show continuing improvement. The rehab or nursing care can be just to maintain their current condition. Medicare said this was not an expansion of coverage - just a clarification. Couldn't a nursing home say this Medicare patient needs our service to maintain their current health. I bet there will be much more written.


about 1 year ago

My husband had a hip replacement, the doctor prescribe him a IRF and MCS in P. R. determine that he has to be in a SNF instead of a IRF, do the Medical Advantage plan can do that? Do Medicare have any regulation for the IRF other than the medical situation and the medical prescription? Please let me know, because I think it is not fair for the patient?


over 1 year ago

i hate the fact that i have to pay medicare premiems as i am a disabled veteran and the va takes care of all my medical needs as a benefit i receive, i do not use my medicare and have been required to pay for it since 2004, what are my options? thank you in advance


over 1 year ago

My father lives in MT and four of his five children live in Spokane WA. Dad has suffered a stroke and will need physical therapy and speech therapy. He is on medicare. He is still in the hospital, but we want him to get his rehab in Spokane so that we can be close to him. He has no one in MT to care for him. Is there any problem with him being treated in WA when he is released from the hospital in MT? I need help fast, thanks


over 1 year ago

Is a Medicare pt. in a nursing home allowed to attend a family party in another state, barely over the border, for a few hours ?


Anonymous said almost 2 years ago

I am going to hospital. Will be there approx. 2 days to have knee replacement (complete)surgery . I live alone. Dr. says i should have rehab care how do I find a place and will medicare cover it?


Anonymous said almost 2 years ago

Long Term Care is something everyone should pay for and plan on, the younger the better and cheaper. Medicare will be going away, and certainly never has or will have provisions for Long Term Care. Our Government is broke and everyone will be on their own. Start planning early! For your kids sake.


almost 2 years ago

Hi, I am enjoying here through your article. I want to give thanks for nice article. I want to write a little comment to support you In your little article has very huge information for Medicare Insurance plans. It is a very surprise for us that we can choose right Medicare insurance plans. I want to give again thanks for this fantastic post. Thanks, <b><a href=" http://www.mymedicareadvisor.com/florida-medicare/"> Florida Medicare</a><b/>


over 2 years ago

The info pertaining to nursing home (skilled nursing services) for Medicare Part C -- both services and copays.


over 2 years ago

Hello minniemee, Thank you very much for your post. If you'd like to find care facilities and resources for your loved one, you can visit our local directory and find a provider in your area: ( http://www.caring.com/local ). If you have additional questinos, you can also post them in our Ask & Answer section, here: ( http://www.caring.com/ask ). Take care -- Emily | Community Manager


over 2 years ago

i have a relative that has kindney failure he is blind and girlfriend has lots of cats and there is cat crap everywhere , now in 5 days he has to have open heart surgery one hour away how can we get help ?????


Anonymous said about 3 years ago

My grandmother is in a skilled nursing home for rehab. The Dr. sent her there right from the hospital for about a week to get more stable and strength before she went home. Now she is ready to go home but they are telling her that she will have to pay out of her pocket the rest of the 21 days. Don't understand why?? Can someone help us with this please?


about 3 years ago

Do you have a nursing home in Puerto Rico near vega baja that accept Medicare?


over 3 years ago

Thanks so so much for this information. For the one's in this situation, we don't even know where to start, what to do, how much is the person is going to suffer for the change, from a home to a nursing home, how guilty I'm going to feel even if I know that it will be the best for my mom, and I know it will be so devasted. I have to bring my mom from NY to live with me, 2 years ago, and she is showing syntoms of dementia or memory lost (Moderate-stage of Alzheimer). I'm so scare by not been recognized by her one day. One day, after coming out of the hospital, she didn't recognize me and was calling as if I was an stranger, a nurse, and I bursted crying, I couldn't take it, then she snaped out of it. With all this information you are giving here, is for any of us with this situation, at least to get prepare, and have some guidance on how to do it. Thanks so much


Anonymous said over 3 years ago

We pay into medicare they whole time we work,correct? Why is no long-term care covered for our elderly.


over 3 years ago

give some non-medicare options...............tks


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