Summary of Medicare Long-Term Care Benefits
Care in a Skilled Nursing Facility (SNF)
An SNF is an institution that provides skilled nursing or rehabilitation. Medicare covers room (semi-private) and board, skilled nursing and therapy services, and other medically needed care.
To Qualify:
- The patient must have a hospital admission of at least three days,
- SNF care must be related to that admission,
- SNF admission must occur within 30 days of hospital discharge,
- A physician must certify daily skilled nursing care is needed, and
- Care must be in a Medicare-approved SNF.
Limits, Deductibles, and Copayments:
- Medicare covers 100 days per benefit period.
- There is no limit on benefit periods in a person’s lifetime.
- Medicare covers 100% for the first 20 days.
- Patients must pay a copayment of $139 per day for days 21 to 100.
- There is no coverage after 100 days.
Home Health Care
Home health care is part-time or intermittent skilled nursing services. It can include physical, speech, or occupational therapy; home health aides if in conjunction with other covered services; durable medical equipment; wound care; and medical social services under the direction of a physician.
To Qualify:
- The patient must be homebound;
- A physician must certify the need for skilled nursing or speech, physical, or occupational therapy;
- A physician must sign a care plan; and
- Services must be provided by a Medicare-approved home health agency.
Limits, Deductibles, and Copayments:
- Medicare Part A covers up to 100 visits following a hospital stay.
- Medicare Part B covers without a prior hospitalization with no limit on visits.
- Coverage is limited to the time period during which the patient needs skilled care; coverage of skilled nursing and home health aides is limited to “part-time” and “intermittent.”
- There is no copayment for services, but there is a 20 percent copayment for durable medical equipment.
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