Who is eligible for Medicare (Part A) Skilled Nursing Facility benefits?
Medicare Part A (Hospital Insurance) may cover care in a certified skilled nursing facility if it's medically necessary for them to have skilled nursing care. However, most nursing home stays are for custodial care. Custodial care provides services like assistance with bathing or dressing. Medicare doesn't cover custodial care if that's the only care they need.
People with Medicare are covered in a skilled nursing facility if they meet all of the following conditions:
They have Medicare Part A and have days left in their benefit period.
They have a qualifying hospital stay which means that the they must spend at least three consecutive days in a hospital as an inpatient.
The Medicare recipient must enter the nursing home no more than 30 days after a hospital stay
In order to be considered "skilled," nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse.
The skilled services are provided in a skilled nursing facility that is certified by Medicare.
They need these skilled services for a medical condition that was either:
For a condition related to the qualifying hospital stay
Or a condition that started while they were getting care in the skilled nursing facility for
a hospital-related medical condition.
Their doctor may order observation services to help decide whether they need to be admitted to the hospital as an inpatient or can be discharged.
During the time, they are getting observation services in the hospital, they are considered an outpatient.
They cannot count this time towards the 3-day inpatient hospital stay requirement