Medicare covers certain skilled care services, including skilled nursing care and skilled rehabilitation care, that are needed daily on a short-term basis of up to 100 days.
Patients with Medicare Part A are eligible for skilled care coverage after hospitalization at a Medicare-certified Skilled Nursing Facility (SNF), provided that certain criteria are met, including: The patient must have had a qualifying inpatient hospital stay of three consecutive days or more (not including the day he or she leaves the hospital), and the patient must enter the SNF within a specified period of time after leaving the hospital (usually within 30 days). In addition, the patient's doctor must have ordered such services, and the skilled care must be needed on a daily basis (or as many days as the service is offered, in the case of therapy services that may be available less than seven days a week). Co-pays also are required for stays of more than 20 days. In 2013, the co-pay for days 21-100 is $148 per day.
Skilled care requires the involvement of skilled nursing or rehabilitative staff such as registered nurses, licensed practical and vocational nurses, physical and occupational therapists, speech-language pathologists, and audiologists. Examples of skilled care functions include intravenous injections and physical therapy. Care that can be given be non-professional staff does not qualify as skilled care.
Medicare will not provide coverage if the need is strictly for custodial care, i.e., help with normal daily activities such as eating, bathing, dressing, bathroom assistance, and simple medical matters such as help with eye drops or oxygen.
Medicare also will pay for certain health care services in your home if you meet eligibility requirements and if the services are considered reasonable and necessary for the treatment of your illness or injury. In order to receive such benefits, you must be under the care of a doctor, who must certify your need for intermittent skilled nursing care, physical therapy, speech-language pathology services, and/or continued occupational therapy. The home healthy agency providing the care must be Medicare-certified.
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