Medicare

Medicare is a benefit provided by the Federal government that helps cover patients in
a Skilled Nursing Facility (SNF).  Patients who no longer need intensive hospital care
but still need skilled nursing care and rehabilitation services on a daily basis can use
their Medicare benefits.  However, Medicare does not cover long term care or nursing
home care that is personal or custodial (example: help with dressing, bathing and eating).

Medicare has Two Parts: 

• Part A (Hospital Insurance) - hospital care, home health care and care in a Skilled Nursing
• Facility. If you are eligible for Medicare, you do not pay a premium for Part A. If you are not
• eligible, you may enroll by paying a monthly premium.

• Part B (Medical Insurance) - helps cover many medical services and supplies not

• covered by Part A. Part B coverage requires a monthly premium.

To be eligible for Medicare benefits, you must be: 

• Age 65 or older and have worked long enough to be insured under Social Security, the Railroad
• Retirement system or the federal government.

• Under 65 and have received disability benefits through Social Security for more than 24
• months.

• Already receiving benefits from Social Security or the Railroad Retirement System.

• A person who has permanent kidney failure

If you’re covered by Medicare, you can qualify if you meet all conditions. You must:

• Be certified by a Doctor that you need daily skilled nursing or rehabilitation services.

• Need daily care that can only be provided in a Skilled Nursing Facility on an inpatient basis.

• Have been in a hospital for at least 3 consecutive days, not counting your day of discharge.

• Be admitted to a Medicare-Certified SNF within 30 days of your hospital discharge.

• Receive Care in the Skilled Nursing Facility for a Condition that was treated in the hospital.

MEDICARE  PART A 

Medicare Part A insurance helps cover up to 100 days of care in a Skilled Nursing Facility per benefit,
if needed.

Part A Benefit Period

• Begins the first day you are admitted into a Skilled Nursing Facility for inpatient care.

• Ends when you have been out of the hospital and not receiving inpatient Skilled Nursing
• Facility care for 60 days in a row.

• There is no limit to the number of benefit periods you can have for Skilled Nursing  
• Facility care.

Benefit Period

• First 20 days of a benefit period - Medicare Part A pays all costs that are covered for Skilled
• Nursing Facility care.

• Next 80 days of a benefit period – Medicare Part A pays all covered costs over $114.00 per day. •

  The $114.00 per day is called a “co-pay” which must be paid by the patient/resident or an
• insurance company that covers the “co-pay” amount.

Skilled Nursing services that Medicare Part A helps cover:

• A 2 to 4 bed semi-private room

• All meals, including special diets

• Nursing Care

• Therapy

• Medications
• Medical supplies such as splints and casts

• Medical equipment such as wheelchairs

MEDICARE  PART B

Medicare Part B helps pay for certain medical services and supplies that Medicare Part A does not cover.

Under Medicare Part B:

• You pay the yearly deductible.

• After you meet the deductible, Medicare usually pays 80% of charges.

• The additional 20% is called “co-pay” which must be paid by the patient/resident or an insurance
• company that covers the “co-pay” amount.

• You also have to pay for any amount over the approved costs.

Medicare Part B helps cover:

• Physician services

• Diagnostic tests

• Certain ambulance services

• Outpatient hospital services

• Physical, occupational, and speech therapy

• Medical equipment used at home

• Mental health care

• Services of other healthcare professionals such as chiropractors, podiatrists and dentists

• under limited circumstances

• Other services and supplies such as pap tests, mammograms, prostate cancer screening,

• and home health care (if the person does not have Part A)