www.OmahaInsuranceSolutions.com
Does Medicare cover skilled nursing facilities? What is skilled nursing? Why is skilled nursing important? After a serious illness, such as a stroke, fractured hip, or car accident, rehabilitation is critical for recovery. Skilled nursing facilities are the places where this is done, but skilled nursing is expensive. Medicare coverage is essential to cover the cost.

All of us have memories of visiting the “old folks’ home.” Whether grandparents, other relatives, or friends, we recall the smells, the linoleum, the long hallways, and institutional dormitory rooms. It is usually not a pleasant memory. Old folks’ homes or nursing homes fall under the category of Skilled Nursing Facilities (SNF).
A Skilled Nursing Facility is an institution that provides post-acute skilled nursing care and/or skilled rehabilitation services. People sometime confuse skilled nursing care with nursing home care because it usually takes place in a nursing home location. But Medicare doesn’t pay for “nursing home care”. In other words, if someone is frail and cannot perform certain activities of daily living, such as bathing, eating, dressing, etc., Medicare will not pay for those services to be provided exclusively. Skilled Nursing is for after surgery or acute illness, for example, hip surgery for a fractured hip or a stroke. Patients are admitted to a skilled nursing facility for a short period of time after being in the hospital to aid in their healing and/or rehabilitation. Hospitals are incredibly expensive, and a skilled nursing facility can provide the necessary treatment at lower cost. A skilled nursing facility would provide intense physical therapy for a hip injury or occupational therapy after a stroke.
The tricky part about skilled nursing facilities is admittance. Certain essential criteria need to be met for admittance to a skilled nursing facility for which Medicare will pay. This is the complex check list:
1. The patient must be admitted to a hospital as an “inpatient” for at least three consecutive days, not including the day of dismissal. The patient can’t be in the hospital for “observation” for it to count.
2. The patient must be admitted to the skilled nursing facility with in 30 days of discharge from the hospital. If problems arise later—past 30 days—the patient cannot go to the skilled nursing facility and have Medicare pay for it.
3. Only a skilled nursing facility can provide the type of care necessary for the patient’s recovery.
4. A doctor, or appropriate medical professional, must certify that skilled nursing care is required for recovery.
5. The patient must be treated for the same condition for which she was in the hospital.
There are nuances and exceptions to some of these rules, but this list gives you a good idea about how skilled nursing fits into your Medicare health insurance.