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5 qualifiers for Medicare's nursing home coverage

Diabetes-screening tools and medications can be costly. Be sure you choose the right Medicare plan to best cover your individual health-care needs.

What happens if you get sick or injured and need skilled nursing care? If you’re covered by Medicare, you can immediately breathe a sigh of relief because it’s got you covered. That is IF you have the right Medicare plan.

Medicare offers three basic coverages — Parts A, B and D — with each having its own role in your health care. Medicare Part A, which includes hospital insurance, offers skilled nursing care for rehabilitation from surgery or injuries. Having Part A, however, does not guarantee skilled nursing care. The medical reasons for the stay must meet a certain criteria, along with other stipulations. The five qualifiers for a stay in a skilled-nursing facility are:

1. Three nights in a hospital — You must be admitted to a qualifying hospital and stay at least three nights in admitted care.

2. Doctor’s approval — A physician must determine you need this particular level of care.

3. Direct supervision — The care must take place under the direct observation of a skilled-nursing or rehabilitation staff.

4. Approved facility — The services must take place in a Medicare-approved facility.

5. Participate in recovery — You must take part, if able, in your daily skilled care or therapy, or Medicare could yank your coverage.

Medicare covers up to 100 days of skilled-nursing care as long as you continue to meet the requirements. From 1-20 days, Medicare pays for all covered services, and from 21-100 days, you have a required co-payment. After the 100th day, Medicare offers no benefit coverage.

Some of the things covered by Medicare in a skilled-nursing facility include (but are not limited to):

• semi-private rooms

• necessary physical and occupational therapy

• speech and language pathology services if needed for your recovery

• medical social services

• medications

• medical supplies and equipment used in the care facility

• ambulance transportation if necessary

• dietary counseling

Before heading into a skilled-nursing facility, check with the facility’s administration and your Medicare advisor to make sure you are fully covered.

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