Ikey Fowler

Last week we discussed how Medicare Part A will cover you if you are admitted into the hospital. A hospital, under Medicare, can be acute care hospitals, critical care hospitals, inpatient rehabilitation facilities, long term care hospitals or mental health care.

The one aspect of Medicare Part A we get the most questions about is coverage at a skilled nursing facility (SNF). To be covered by Medicare at a SNF certain criteria has to be met. First, of course, is you must have Medicare Part A. Next your doctor has determined that you need daily skilled care given by, or under the supervision of, skilled nursing or therapy personnel. Your skilled nursing care will have to be in a SNF that is certified by Medicare.

What a lot of people don’t know is that you must have a “qualifying” hospital stay to be covered at a SNF. Under Medicare a “qualifying” hospital stay is at least a 3-day inpatient stay prior to being admitted to the SNF. If you go to the ER and are held one day for observation and are admitted into the hospital for two days this does not constitute a “qualifying” hospital stay. If you are admitted on a Monday and discharged the following Wednesday this is not a “qualifying” hospital stay. In the two examples above those are 2-day inpatient stays. A good rule of thumb is you must be admitted as inpatient for at least three midnights.

You also need to know that Medicare Part A will only cover you for 100 days at a SNF and only 20 of those days are at 100%. In other words days 1-20 are covered at 100%. Days 21-100 you will pay the first $185.50 per day and Medicare pays the rest of the cost. Starting with day 101 you will pay 100% of the bill.

If you have questions regarding any aspect of Medicare or Medicare health plans feel free call us at Alabama Health Guidance (256-648-5710), stop by our office at 885 Florence Blvd (Four Lane Shopping Center) or email me at ikey@alabamahealthguidance.com.

Alabama Health Guidance is an independent insurance agency and is not affiliated with Medicare or any other government agency.