Medicare’s Skilled Nursing Facility benefit (SNF) primarily covers an individual when an in-patient, but outpatient and homebound benefits are available as well.
Nurses, speech therapists, and occupational therapists are examples of licensed skilled services covered by Medicare. Original Medicare covers skilled nursing claims after a three-day hospital stay. The three-day rule was waived during the pandemic but is back in force as of May 11, 2023. Medicare Advantage plans do not typically have the three-day rule and it would be wise to check the benefit book of your Advantage plan.
Skilled nursing facility benefits are not automatically granted after a three-day hospital stay, one must be recovering and meet certain criteria. The patient must actively participate in skilled services. If the patient cannot or will not participate, Medicare will not cover the SNF charges. Benefits for SNF services last up to 100 days. The catch is that Medicare decides how many of those 100 days will be covered. A family member may believe that their loved one in a SNF is not well enough to come home, but if Medicare determines otherwise, coverage ends. The patient has the right to challenge Medicare’s determination to discharge but that rarely adds more than a few days of coverage, not weeks. It is at this point that the patient must begin spending their life savings to remain in a SNF facility until they are poor enough to qualify for Medicaid… assuming they do not have a Long-Term Care policy.
Medicare will cover the first twenty days in a SNF, after that the patient pays $200 a day. The Senior Security Plan G from Blue Cross Blue Shield of Arizona covers the $200 a day charge. Any Plan G Medicare supplement will cover the $200 daily charge, as all plan G’s must offer identical coverage. When shopping for a Medicare supplement plan you only need to compare price and company reputation.
If a patient qualifies for the full 100 days of SNF benefits, coverage will end after the 100 days until a new benefit period begins. A new benefit period begins after 60 days of being facility-free, or, if remaining in a SNF, the patient or their LTC carrier pays for the SNF during the 60 days. After the 60 days the patient qualifies for another 100 days after a new hospital admission.
Being readmitted to a hospital after a SNF stay is very expensive and Medicare will scrutinize the claims. Another drawback for the patient is that they will likely lose their spot at the SNF while in the hospital and forced to find another SNF after discharge from the hospital. Many LTC policies cover the cost of holding the SNF bed while the patient is in the hospital.