Medicare Eligibility

To qualify for Medicare (Part A) benefits during a stay in a skilled nursing facility (SNF), a beneficiary who is eligible must:

• Have a 3-day qualifying hospital stay (3 consecutive midnights),
• Be admitted to a Medicare certified bed within 30 days, and
• Require skilled in-patient service.

Entitlement

Medicare will pay 100% of all covered services for the first 20 days in a SNF. The beneficiary is liable for a partial payment for each covered day from the 21st through the 100th day.

Benefit Period Criteria

The Benefit Period or “Spell of Illness” Begins with the initial 3-day qualifying inpatient hospital stay.  The Benefit Period Ends only when the beneficiary has been:

• Facility-free for 60 consecutive days
• Or in a Skilled Nursing Facility, but not receiving skilled services for 60 consecutive days

A new benefit period requires another 3-day inpatient qualifying stay in an acute hospital after the minimum 60 consecutive day break in skilled care.

*Definitions

• 3 day qualifying hospital stay: Three (3) days not counting the day of discharge for a condition or treatment in an acute care hospital or complication thereof.
• Daily skilled service: Care is administered or supervised by licensed personnel
• 7 days a week for nursing care
• 5 days a week for therapy (Physical, Occupational, or Speech Therapy)