How long will Medicare cover Mom's stay in a skilled nursing facility?

1 answer | Last updated: Sep 27, 2016
A fellow caregiver asked...

My mom was hospitalized for seven (7) days in April; she was released to a Rehab/Skilled Nursing facility on April 22. As a result of multiple infections and dehydration, she was readmitted to the hospital on July 1. When she is released from the hospital and she returns to Rehab/Skilled Nursing facility (a different facility!!!!!), how long will Medicare Part A cover her stay? I've been told 20 days (bcause she used up 80) and I've been told 100 days (that her 100 days restarts since her readmission to the hospital happened more than 60 days since her last discharge.

Expert Answers

The amount Medicare Part A pays for inpatient skilled nursing care is calculated based on what's called a "benefit period." A Medicare Part A benefit period begins the first day someone is admitted as an inpatient to a hospital or skilled nursing facility (SNF), and continues until that person has been out of both the hospital AND SNF for 60 consecutive days. During any one benefit period, Medicare Part A pays for up to 100 days of SNF care -- for the first 20 days, Medicare Part A pays the full amount; for the next 80 days, the patient is charged a copayment of $141.50 per day.

So, if your mother was out of both the hospital AND the SNF for at least 60 consecutive days before she was readmitted on July 1, a new benefit period would have begun on July 1 and she would be entitled to another 100 days of SNF coverage after she leaves the hospital.

However, it sounds like your mother was in the SNF the entire time from April 22 until her readmission to the hospital on July 1 (since you say she "used up 80 days" of SNF coverage). If so, she will not have begun a new benefit period and will only have 20 more days of SNF coverage from Medicare Part A when she leaves the hospital (regardless of whether it's the same or a different SNF).