![]() ![]() You must enter the SNF within 30 days of leaving the hospital. (This is known as the 3-day rule.) However, due to the COVID-19 pandemic, there are some exceptions that allow coverage to kick in without a prior hospital stay. Typically, you must have been admitted to a hospital as an inpatient for at least 3 days before entering the SNF. You must have Medicare Part A coverage, typically obtained when you turn 65 or when you meet certain eligibility requirements. To be eligible for SNF benefits under Medicare, you must meet the following conditions: How do I qualify for nursing home coverage under Medicare? If you leave and return to the SNF after a few months, you might have to pay the coinsurance again after Day 20. Suppose you go into an SNF for 28 days and pay your share of the costs. Remember that you may have to pay coinsurance during each new benefit period. Once you reach Day 101 of the benefit period, you will be responsible for all costs associated with your stay in the nursing home. If Medicare is your only source of coverage, you could face a bill of up to $16,000 if you remain in the SNF for up to 100 days. As of Day 21, you may be responsible for paying up to $200 of coinsurance daily. You’re responsible for covering all of the costs.įor the first 20 days of the benefit period, Medicare Part A covers the full cost of the skilled care you receive in an SNF. You’re responsible for a coinsurance of up to $200 daily. The table below compares the potential out-of-pocket costs per benefit period, based on the number of days you stay in a facility. The length of time you stay in an SNF affects how much Medicare will pay. What are the out-of-pocket costs you should consider? In this case, you may need to consider other options, such as Medicaid or private insurance. If you need to stay in a nursing home to receive help with activities of daily living - such as bathing, dressing, and eating - or have a chronic condition that requires ongoing care, Medicare generally will not cover those costs. Medicare does not cover long-term care services. While you’ll still be covered, you may have to pay coinsurance at some point in your stay, even if you paid it during the previous benefit period. If you leave the SNF and return 3 months later for additional therapy, Medicare will consider this a new benefit period. Let's say you stay 14 days in an SNF for rehabilitation after hip replacement surgery, and Medicare covers the cost of skilled care services you receive during that time. But these services must be medically necessary and ordered by a healthcare provider. Medicare Part A covers some skilled care services for up to 100 days per benefit period. Other factors that impact the cost of a nursing home include:Įxtra medical care or services you receive That’s almost twice the cost of a nursing home in Texas, which averages approximately $5,100 per month. For example, you can expect to pay about $13,800 a month to stay in a nursing home in New York state. But the costs can be much more or less depending on where you live. On average, nursing homes can cost between $7,900 and $9,000 per month. Original Medicare does not cover long-term nursing home care, but it offers limited coverage for skilled care services in an SNF. ![]() Long-term, or custodial, care focuses on assistance with “ activities of daily living,” such as bathing and eating, and may not need to be performed by licensed professionals. Nursing homes that provide this kind of care are called skilled nursing facilities (SNFs). Skilled care is provided by licensed professionals who treat medical conditions. Nursing homes offer two types of care: skilled and long term. But it’s helpful to know in advance what insurers, like Medicare, will cover. The idea of moving into a nursing home can be overwhelming, even before you start thinking about how to pay for the costs. ![]()
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