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Medicare Skilled Nursing Facility (SNF) Coverage

The information below can be found in the Medicare Coverage of Skilled Nursing Facility Care booklet by the Centers for Medicare & Medicaid Services (CMS) on pages 13-15.

Will Medicare Cover Skilled Nursing Facility Care?

Medicare will cover Skilled Nursing Facility (SNF) care only if all of these are true:

  1. You have Medicare Part A (Hospital Insurance) and have days left in your benefit period available to use.

2. You have a qualifying hospital stay. This means a prior medically necessary inpatient hospital admits you as an inpatient, but not including the day you leave the hospital. Time you spend at the hospital under observation or in the emergency room before you’re admitted doesn’t count toward the 3-day qualifying inpatient hospital stay, even if you’re there overnight. You must enter the SNF within a short time (generally 30 days) of leaving the hospital.

After you leave the SNF, if you re-enter the same or another SNF within 30 days, you may not need another qualifying 3-day inpatient hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start getting skilled care again within 30 days. If you’re in a Medicare Advantage Plan, you might not need to be in the hospital for 3 consecutive days. Check with your plan about costs for a SNF stay. 

3. You need, and your doctor has ordered, inpatient services in a SNF, which require the skills of professional personnel (like doctors, registered nurses, licensed practical and vocational nurses, physical and occupational therapists, speech-language pathologists, or audiologists) and are given by, or under the supervision of, these skilled personnel.

4. You need and get the required skilled care on a daily basis and the services, as a practical matter, can only be given when you’re an inpatient in a SNF. If you’re in a SNF for skilled therapy services only, your care is considered daily care if the therapy services are needed and given just 5 – 7 days a week.

5. You need these skilled services for one of these:

  • An ongoing condition that was also treated during your qualifying 3-day inpatient hospital stay, (even if it wasn’t the reason you were admitted to the hospital).
  • A new condition that started while you were getting SNF care for the ongoing condition. For example, if you’re in a SNF because you broke your hip and you then have stroke, Medicare may cover therapy services for the stroke, even if you no longer need therapy for your hip.

6. The skilled services must be reasonable and necessary for the diagnosis or treatment of your condition.

7. You get these skilled services in a Medicare-certified SNF.

How long does Medicare cover SNF care?

Medicare uses benefit periods to keep track of how many days of SNF benefits you use and how many are still available. A benefit period begins on the day you start getting inpatient hospital or SNF care. You can get up to 100 days of SNF coverage in a benefit period. Once you use those 100 days, your current period must end before you can renew your SNF benefits.

Your benefit period ends:

  • When you haven’t been in a SNF or a hospital for at least 60 days in a row.
  • If you return in a SNF, when you haven’t gotten skilled care there for at least 60 days in a row.

There’s no limit to the number of benefit periods you can have. However, once a benefit period ends, you must have another 3-day qualifying hospital stay and meet these Medicare requirements before you can get up to another 100 days of SNF benefits.

What if I stop getting skilled care in the SNF, or leave altogether? How does this affect Medicare coverage if I need more skilled care in a SNF later on?

This depends on how long your break in SNF care lasts.

If your break in SNF care lasts for less than 30 days:

  • You don’t need a new 3‑day inpatient hospital stay to qualify for coverage of additional SNF care, but you need to meet all other coverage requirements.
  • Your current benefit period would continue. This means that the maximum coverage available would be the number of unused SNF benefit days remaining in your current benefit period.

If your break in SNF care lasts at least 30 but less than 60 days:

  • Medicare won’t cover additional SNF care unless you have a new 3-day qualifying inpatient hospital stay, and you meet all other coverage requirements. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.
  • Your current benefit period would continue. This means that the maximum coverage available would be the number of unused SNF benefit days remaining in your current benefit period.

If your break in SNF care lasts at least 60 days:

  • Medicare won’t cover additional SNF care unless you have a new 3-day qualifying inpatient hospital stay and all other coverage requirements are met. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.
  • Your current benefit period would end and your SNF benefits would be renewed. This means that the maximum coverage available would be up to 100 days of SNF benefits in your new benefit period.

What does Medicare cover when I qualify for SNF care?

Medicare covers:

  • A semi‑private room (a room you share with other patients)
  • Meals
  • Skilled nursing care
  • Medical social services
  • Medications
  • Medical supplies and equipment used in the facility
  • Ambulance transportation (when other transportation would endanger your health) to the nearest supplier of medically‑necessary services that aren’t available at the SNF, including the return trip
  • Dietary counseling

Medicare covers physical therapy, occupational therapy, and speech language pathology services if they’re needed to meet your health goal. A health goal is the expected result of your treatment, like being able to walk a certain distance or to climb stairs.

For more information on SNF or SNF Care Coverage, please see the Medicare Coverage of Skilled Nursing Facility Care booklet by the Centers for Medicare & Medicaid Services (CMS). You can access the booklet through the link at the top of this article.

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