Medicare covers up to 100 days of SNF care per benefit period. Learn what happens when your coverage runs out, how to qualify for a new benefit period, and alternative options for continuing care. Original Medicare measures your use of the services of a hospital and a skilled nursing facility (SNF) during benefit periods. The benefit period begins the day you are admitted as an inpatient to a hospital or SNF.
The benefit period ends when you haven't received any type of inpatient hospital care (or specialized care in an SNF) for 60 straight days. If you enter a hospital or an SNF after a benefit period has ended, a new one begins. You must pay the hospital deductible for inpatients for each benefit period. There's no limit to the number of benefit periods you can have.
Part A limits SNF coverage to 100 days in each benefit period. What happens if I stop receiving specialized care in the SNF or leave the SNF completely? After a serious injury or medical event, your top priority is finding your path to recovery, and understanding how you're going to pay for them can be stressful. For millions of Americans, the answer lies in Medicare, but the system is confusing, especially when choosing between an inpatient rehabilitation center (IRF) and a skilled nursing facility (SNF), often referred to as nursing home. For any post-hospital stay, the coverage you'll use is Medicare Part A (hospital insurance).
This is the part of Medicare that helps pay for the care you receive as an inpatient. The costs we'll discuss below generally apply once you've met your Part A deductible for your benefit period. The benefit period begins on the day you are admitted as an inpatient and ends when you haven't received any type of hospital care for 60 consecutive days. An SNF provides specialized nursing and therapy services, but at a lower intensity than an IRF.
Medicare coverage for an SNF is more limited and has a tiered cost structure. Choosing the right level of care is about achieving the best possible recovery. For patients who can participate in intensive care, the IRF model is designed to get them home faster and more independently. So how long does Medicare pay for rehabilitation after a hospital stay? The summary answer is 20 days, during which Medicare covers 100% of the costs for eligible patients to receive rehabilitation in a skilled nursing facility.
Between 21 and 100 days, patients are responsible for paying for coinsurance, and after 100 days, patients are responsible for paying the full cost. Once you reach your deductible, Part A will cover days 1 to 60 you're in the hospital. For days 61 to 90, you'll pay for coinsurance for each day. If you need to stay in the hospital longer than 90 days, you can use up to 60 days of a lifetime reservation.
These are additional days of Medicare coverage for extended hospital stays. However, lifetime reserve days are not renewable and require daily coinsurance payment. Ask your provider if you are eligible for home treatment through the Medicare home health benefit, or if you can be treated safely as an outpatient. An outpatient is a patient who has not been formally admitted to the hospital as an inpatient.
For a stay in a skilled nursing facility, most Medigap plans will cover the daily coinsurance payment required for days 21 to 100, which can save you a significant amount of money. The Medicare Part A benefit period for a hospital stay or an SNF starts the day you're admitted and ends when you've been out of the hospital or SNF for 60 consecutive days.
If you need specialized care and are homebound, you may be eligible for Medicare home health care coverage.
However, you don't have to pay the Part A deductible for care at a skilled nursing facility if you already paid for the care you received at a hospital during the same benefit period. Keep in mind that Medicare doesn't usually pay for the full cost of your care and you're likely responsible for a portion of the shared costs (deductibles, coinsurance, copays) of services covered by Medicare.For those who qualify, Medicare Part A covers up to 100 days of SNF rehabilitation per benefit period. In general, if you're 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years, you won't pay any premiums for Medicare Part A. There you'll find more information about ways to prepare for Medicare, when and how you should enroll, what to do if you plan to work beyond age 65, options to supplement Medicare, and resources for more information and assistance. Remember that you can once again be eligible for Medicare coverage for your SNF care, once you've been out of the hospital or SNF for 60 straight days. Medicare Part A can cover up to 100 days of home health care if you spent 3 days or more as an inpatient within 14 days of receiving home health care.
