If Medicare runs out, can it be restarted?

A fellow caregiver asked...

My brother-in-law went into the hospital after suffering a stroke. He was then assigned to a skilled nursing facility. He had both Medicare and Tricare. Now both have run out. Here is the question: if he went back into the hospital for two days will Medicare or Tricare pay for his care when he is returned to the facility?

Expert Answer

Medicare payments for care in a skilled nursing facility last for only 100 days within any one "benefit period." Within that 100 days, Medicare pays the full amount for the first 20 days, then requires the patient to pay a daily copayment during the next 80 days. TRICARE pays that copayment. After 100 days, though, Medicare covers no more skilled nursing facility coverage within that same benefit period.

The whole payment cycle for your brother-in-law's skilled nursing facility care could begin again, however, if he enters a new benefit period. In that new benefit period, Medicare would again pay for another 100 days, with TRICARE paying copayments. You've rightly identified part of what's needed for new Medicare skilled nursing facility coverage -- a new hospital stay. But that new hospital stay must be for 3 days (not counting the day of discharge), not 2 days. And there's another requirement that must be met before Medicare considers that your brother-in-law has entered a new benefit period. That is, he must have been OUT of both the hospital and the skilled nursing facility for 60 consecutive days before a new benefit period can begin. Unless he has that 60-day period out of the hospital and skilled nursing facility, a new Medicare benefit period does not begin and there is no further Medicare coverage for his nursing facility stay.