Original Medicare offers some benefits for Skilled Nursing but if you are not careful you could pay 1000's of dollars out of your own pocket. Before we get started we need to explain what we are talking about.
Skilled Nursing is not for old people stuck at home in bed
When you have a nurse in your home that help you get in and out of bed and feeds you that is called Custodial Care. Medicare doesn't cover Custodial Care. Skilled Nursing is inpatient rehab. We are talking about Physical Therapy or Speech Pathology in a special overnight facility here..not help getting dressed. If you need serious treatment for your post hospital stay then you need Skilled Nursing.
Skilled Nursing is partially covered under Medicare
Medicare pays for the first 20 days of inpatient rehab. If you stay for more than 20 days you will have to pay $148 dollars a day of your own money for the next 80 days (2013 numbers). That could add up to $11,840 over 80 days. You can address that cost with a Medigap plan but that may be the least of your problems...
Medicare may not pay for any of your coverage if you are not careful
Medicare Skilled Nursing will not be paid for unless you are admitted to a hospital for at least 3 days. That sounds pretty straightforward but you could be burned if you don't read the bullets below.
- The day you leave a hospital does not count towards the three days. So if you exit the hospital after three days it only counts as two days and you will have to pay 100% of the cost of inpatient rehab.
- Hospitals often keep you in the hospital but you are not officially admitted. It's called "observation" when you are in the hospital and not admitted. You may never know that you were not admitted to the hospital until Medicare refuses to pay for your inpatient rehab because you weren't admitted for the required 3 full days
Steps to make sure you are covered for Medicare Skilled Nursing
1) Make sure you are officially admitted to the hospital for 3 full days before seeking inpatient rehab treatment. Ask your doctor to confirm that you are "admitted" and not just under "observation."
2) Consider a Medicare Supplement plan (Medigap) to pay for the portion not covered by Medicare. Medigap plans C, D, F, F-high deductible, M and N all cover 100% of the $148 daily copay for an additional 80 days per benefit period.
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