The majority of individuals admitted to a skilled nursing facility have not met requirements of a Medicare-covered stay. The following criteria must be met in order for a person to be eligible for Medicare Part A benefits in the skilled nursing facility:

• A physician must certify that you need skilled nursing care
• You must be admitted to the facility within 30 days of discharge from a hospital stay of 3 or more qualifying days (not including your discharge day)
• You must require some type of skilled nursing or therapy services that meet Medicare criteria. For example: someone having suffered a stroke who needs skilled therapy and nursing services for rehabilitation.

If you have met these criteria, you will be eligible for a maximum benefit period of 100 days. There are no guarantees that you will receive this maximum, you only continue to receive the benefit if you are continuing to progress with the skilled services being provided. When a person is no longer showing progress or has met their goals, the Medicare Part A coverage will end.

During the first 20 days of this benefit period, Medicare pays all cost including semi-private room charges, any skilled therapy or nursing services, medications and any other ancillary charges.

The next 80 days of the benefit period, Medicare Part A will pay all the above cost, with the exception of a required co-pay amount. Private insurances, private funds or Medicaid can meet this amount.

At any time during the 100-day benefit period the coverage can end if the recipient is no longer meeting skilled care criteria. Prior to Medicare coverage ending, the resident and/or his agent will be notified in advance to allow time to transfer to another payment source.

Please contact us for more information. We look forward to your call.