What Are the Medicare Coverage Qualifications for Skilled Therapy Services in a Skilled Nursing Facility (SNF)?

SNF care is post-hospital care provided at a skilled nursing facility. Skilled nursing care includes services such as administration of medications, tube feedings, and wound care. Keep in mind that SNFs can be part of nursing homes or hospitals. Medicare Part A may cover your SNF care if:

  • You were formally admitted as an inpatient to a hospital for at least three consecutive days
  • You enter a Medicare-certified SNF within 30 days of leaving the hospital and receive care for the same condition that you were treated for during your hospital stay
  • And, you need skilled nursing care seven days per week or skilled therapy services at least five days per week

If you meet all of the above requirements, Medicare should cover the SNF care you need to improve your condition, maintain your ability to function or prevent your health from getting worse. Speak to your doctor or hospital discharge planner if you need help finding an SNF that meets your needs. Ask them to find Medicare-certified SNFs in your area that will address your medical needs. If you are in a Medicare Advantage Plan, contact your plan to find out which SNFs are in their network

During a Medicare-covered skilled nursing facility stay, Part A covers:

  • A semi-private room and meals
  • Skilled nursing care provided by nursing staff
  • Therapy, including physical therapy, speech therapy, and occupational therapy
  • Medical social services and dietary counseling
  • Medications
  • Medical equipment and supplies
  • Ambulance transportation to the nearest provider of needed services, when other modes of transportation would endanger your health

Each benefit period, Part A covers the full cost of your first 20 days in an SNF. For days 21-100, Part A covers part of the cost and you pay a daily coinsurance ($176 in 2020).

  • Benefit periods measure your use of inpatient hospital and skilled nursing facility services. A benefit period begins the day you are admitted to a hospital as an inpatient, or to an SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row.

Read More: Am I Eligible for Medicare Coverage of Skilled Therapy Services as Part of Home Health Care?
Learn About: How Do I Appeal to Medicare Ending My Skilled Therapy Services?
Return to: Medicare In-Depth

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