1: How does Medicare work?
This is a basic outline of information for what you pay if you have Original Medicare Part A for covered services and items for a skilled nursing facility stay:
- You pay $0 for the first 20 days each benefit period.
- You pay a coinsurance per day for days 21-100 each benefit period and coinsurance (also known as co-pay) is set annually by Medicare.
- You pay all costs each day after day 100 in a benefit period.
- If you are in a Medicare Advantage Plan, costs vary by plan. Check with your plan.
- Part A covered services in a skilled nursing facility care includes semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies (only after a 3-day minimum inpatient hospital stay for a related illness or injury.)
- To qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care.
- Medicare does not cover long-term care custodial care.
- Medicare has specific guidelines for the number of hours you may be away from the facility.