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- 1101 Waterwell Rd. | Crossett, AR 71635
Skilled nursing care can ease the transition from hospital to home, and Medicare may cover all or some of the costs. However, you can only get coverage if you meet certain requirements. This often leaves people to ask, “What are Medicare requirements for skilled nursing facilities?”
To shed light on this topic, we’ve created this helpful guide to Medicare requirements for skilled nursing facilities (SNF).
For Medicare to cover skilled nursing care, you must usually meet all the conditions in the flowchart below.
We can help you determine whether you’re eligible for Medicare requirements for skilled nursing facilities. If you have Medicare Part A (Hospital Insurance), you may have short-term coverage for skilled nursing care from a facility. However, you aren’t automatically eligible for this specialized care. So, what are Medicare requirements for skilled nursing facilities?
You might have noticed that the chart above mentioned the need to have a “qualifying inpatient hospital stay.” However, what does this mean?
Medicare considers a “qualifying inpatient hospital stay” to be a medically necessary inpatient hospital stay of at least three (3) days in a row. This timeframe starts on the day you were admitted for inpatient care.
However, the following does not count toward your three-day requirement:
In some cases, you don’t need to have a three-day minimum inpatient hospital stay. One example is if your doctor participates in an Accountable Care Organization. Another is if your Medicare Advantage Plan waives the three-day minimum.
Medicare will only cover skilled nursing care on a short-term basis. This often leaves many people wondering how long Medicare will pay for care. It also brings up a question about how much a person can expect to pay after Medicare stops fully covering skilled nursing care.
The following table answers both of these questions:
| Time in Skilled Nursing Facility | Cost to Patient |
| Days 1-20 | $0* |
| Days 21-100 | Requires a daily co-insurance payment that equals 80% covered by Medicare and 20% co-insurance paid by patient |
| Days 101 and beyond | All costs (unless the patient starts a new 60 day wellness period) |
*You may have a copayment during the first 20 days if you’re in a Medicare Advantage Plan. Be sure to check with your plan for more details.
Our caring and knowledgeable team of licensed providers can do more than answer the question “What are Medicare requirements for skilled nursing facilities?” We’re also trained to provide comprehensive and compassionate care that helps people like you move from hospital to home.
We care for patients who are recovering from surgeries, healing from fractures, and facing new diagnoses like Parkinson’s Disease. To address the unique needs of the people we serve, Nightingale at Crossett offers a wide range of services to promote health and healing:
Best of all, we offer thoughtful touches and amenities to help our facility feel like a home away from home. Why do we do it? Because we treat our patients the way we would want our own family members to be treated.
Now that you know the Medicare requirements for skilled nursing facilities, we invite you to reach out to Nightingale at Crossett. Our state-of-the-art facilities, comprehensive care, and talented team are here to support you or your loved one as you transition from hospital to home.
Our approach to care is inspired by our belief that our patients deserve nothing less than the best. Contact us to learn more about our skilled nursing facility and how we can help you rediscover health and strength.