Medicare Coverage Post Inpatient Hospitalization

Medicare might cover you if you need to go into a skilled nursing facility (SNF) after having been an inpatient in an acute care hospital.   

 A stay at a SNF post-hospital stays include specific services like for the administration of tube feedings, and wound care. 

 To receive coverage under Medicare Part A for a stay at a SNF you will need to meet the following requirements: 

1-    You had been admitted as an inpatient to a hospital for at least three consecutive days (see: How to Count the Days).

2-    You enter a Medicare-certified SNF within 30 days of leaving the hospital and need to receive care for the same condition that you were treated for during your hospital stay. 

3-    You need skilled nursing care seven days per week or skilled therapy services at least five days per week 

How To Count The Days

1-    The day that you become an inpatient in a hospital counts toward your three-day in patient stay.  

2-    The day you are discharged from the hospital does not count toward your qualifying days. 

3-    The time spent receiving emergency room care or if you are under observational status does not count toward the three-day hospital inpatient requirement for SNF coverage. 

If you meet all the above requirements, Medicare should cover the SNF care as long as it can be demonstrated that you need to improve your condition, maintain your ability to function, or prevent your health from getting worse. 

Coronavirus Exception

The three day qualifying stay at an inpatient hospital has been waived because of the coronavirus public health emergency for beneficiaries who experience dislocation or are otherwise affected by the coronavirus public health emergency. According to Medicare, this waiver includes but is not limited to beneficiaries who: 

· Need to be transferred to a SNF due to nursing home evacuations or to make room at local hospitals.

· Need SNF care as a result of the current public health emergency, regardless of whether they were previously in the hospital. 

You should always speak with your doctor or the hospital discharge planner if you need help finding a SNF that meets your needs. Ask them to find Medicare-certified SNFs in your area that will address your medical needs. 

If you are in a Medicare Advantage Plan, contact your plan to find out which SNFs are in their network.