Does Medicare Part B Cover Skilled Nursing Facility?

Diane Carbo

Oct 8, 2023 • 9 min read

Medicare Part B is a health insurance plan offered by the U.S. federal government for Americans 65 or older

Introduction to Medicare Part B

Medicare Part B is a health insurance plan offered by the U.S. federal government for Americans aged 65 or older, as well as certain disabled individuals. It is designed to cover both medically necessary and preventive health services, including doctor visits, hospital stays, outpatient care, blood tests, X-rays, mental health services, and durable medical equipment.

Part B also covers some home health services such as physical therapy, speech-language pathology, skilled nursing facility (SNF) care, and certain preventive services.

What is a Skilled Nursing Facility (SNF)?

A Skilled Nursing Facility (SNF) is a type of health care facility that provides short-term medical and nursing care to patients who have experienced an illness, injury, or surgery. They also provide long-term care for people with chronic medical conditions. These facilities are staffed by nurses and other healthcare professionals who can provide a wide range of services to help their patients become healthier.

What Types of Services Does a SNF Provide?

The range of care and services offered by a SNF depends on the individual facility, but some common services include:

24-hour skilled nursing care
Physical therapy
Occupational therapy
Speech therapy
Social services and activities for patients
Dietary counseling
Wound care
In-house laboratory and radiology services
Medication management

SNFs are often the preferred choice when someone needs short-term care during the recovery period following a hospital stay. They provide an environment that is less clinical than a hospital, while still providing high quality medical care that can help patients get back on their feet.

Medicare Part B and Skilled Nursing Facility Care

Medicare Part B is a federal health insurance program that helps cover medically necessary services like doctor visits, outpatient care, durable medical equipment, and some preventive services. But does it cover skilled nursing facility (SNF) care? Yes, but with certain caveats.

SNFs provide 24-hour medical and nursing care for people who need more help than simple home health care but don't need to be at a hospital. They offer a range of services such as physical and occupational therapy, wound care, and special treatments for conditions such as dementia. Medicare Part B covers a certain number of days per year of SNF care for certain medical conditions.

To qualify for coverage under Medicare Part B, you must have a qualifying diagnosis, be discharged from the hospital after a qualifying hospital stay, and receive skilled care from a provider that's enrolled in Medicare. Additionally, you must continue to show a need for skilled care which can only be provided through an SNF setting.

The costs associated with SNF care that are covered by Medicare Part B include room and board, medications, and supplies used during your stay. If there are additional services that you would like to receive, such as physical therapy or skilled nursing services, you may have to pay for these out of pocket.

When is a Skilled Nursing Facility Required?

There are some situations where a patient may be required to use a Skilled Nursing Facility (SNF). These can include if they require skilled medical care that can only be performed at an SNF, such as wound care, or if they are unable to return home after a hospital stay due to physical disability or medical condition. In some cases, even if the patient is able to return home, an SNF may still be recommended if there is a need for ongoing rehabilitation or nursing care.

It is important to know that not all SNF services will be covered by Medicare Part B. For instance, Medicare will not cover custodial care, which is defined as non-skilled personal care such as help with activities of daily living (e.g., bathing, dressing, eating).

If a patient requires SNF services, they should contact their local Medicare provider to find out if the service is covered under Medicare Part B and what the specific coverage criteria are.

Exploring Additional Costs for a Skilled Nursing Facility (SNF) and Medicare Part B Coverage

A Skilled Nursing Facility (SNF) provides a wide variety of necessary services that are not available at home. These services may include physical, occupational and/or speech therapy, as well as medical supervision, nursing care, and other services. In many cases, a stay in an SNF is shorter than a stay in a hospital, yet it may be more costly due to the cost of room and board, medications, supplies, etc.

Medicare Part B covers certain costs associated with a stay in an SNF including some of the room and board costs. The coverage criteria vary slightly from state to state, so it’s important to check with your local Medicare provider to understand what type of coverage you qualify for. Generally speaking, Medicare Part B will cover up to 100 days of care during any given spell of illness. However, the first 20 consecutive days are covered in full, while days 21-100 are only covered at 80%.

In addition to the room and board charges, Medicare Part B may also cover medications, supplies, and other services that are deemed medically necessary, but this will vary based on the patient's individual circumstances. It’s important to note that if the patient’s condition improves during their stay and they are eventually able to return home, then they will need to apply for Medicare Part A coverage for the remaining costs.

Medicare-mandated Coverage Criteria for Skilled Nursing Facility Services

Medicare Part B offers coverage for skilled nursing facility (SNF) services. However, this coverage is only available for medically necessary care and treatments that meet specific criteria set by Medicare.

In order to qualify for SNF coverage under Medicare Part B, you must:

Have been admitted to a Medicare-certified SNF within 30 days of being discharged as an inpatient from a hospital or from another SNF.
Be certified by your doctor as needing medically-necessary care, treatment, or services.
Require daily care and treatment that can only be provided in a SNF setting.

To receive full coverage for SNF services, Medicare rules require that your doctor must certify the medical necessity of care in the SNF for a period lasting at least three consecutive days. If you’re not sure if you meet the criteria for SNF coverage, talk to your doctor or contact your local Medicare provider.

Medicare Part B: What Conditions and Treatments Are Not Covered at an SNF?

It is important to understand what conditions and treatments Medicare Part B will not cover, if you or a loved one are receiving care at a Skilled Nursing Facility (SNF). There are certain treatments and conditions that Medicare Part B does not provide coverage for. Understanding this list can help you avoid costly fees for services not covered.

In general, Medicare Part B does not cover the following treatments and conditions:

Non-skilled custodial care, such as help with activities of daily living (ADLs) like bathing, dressing, and eating
Care for chronic conditions unrelated to a recent hospitalization, such as Alzheimer’s Disease and multiple sclerosis
Respite care, meaning short-term beds for caregivers
Any experimental treatments or procedures
Specialized equipment, such as wheelchairs and walkers

It’s also important to remember that if a patient needs to stay longer than the recommended 100 days in a SNF, it is unlikely that Medicare Part B will continue to cover their stay. Once the 100-day limit has been reached, coverage for the SNF services will stop.

Patients should keep in mind that Medicare Part B is not a guarantee of all costs associated with an SNF. While Medicare Part B covers some SNF services, it is important to contact your local Medicare provider about what treatments and services are covered by the plan.

Differences between Medicare Part B and Medicare Part D

Medicare Part B covers a variety of health care services, but it does not cover all medical costs. It is important to understand the differences between Medicare Part B and Medicare Part D and how these affect coverage of skilled nursing facility (SNF) services.

Medicare Part B provides coverage for medically necessary medical services such as doctor visits, preventative screenings, and therapeutic treatments. Medicare Part D, on the other hand, provides coverage for medications, including some prescription drugs. Medicare Part D also includes coverage for durable medical equipment such as oxygen tanks, walkers, and wheelchairs.

Medicare Part B covers certain SNF services if they are considered medically necessary. Medicare Part D does not provide coverage for SNF services, but it may provide coverage for certain medications and supplies related to SNF care. For example, Medicare Part D may cover some medication or supplies used in an SNF setting, depending on the patient's prescription drug plan.

It is important to understand the differences between Medicare Part B and Medicare Part D to ensure that you are getting the right coverage for SNF services. If you have any questions, contact your local Medicare provider for more information.

If your SNF service does not qualify for Medicare Part B coverage, you’ll still be responsible for the cost of the service. It’s important to be aware of all out-of-pocket costs that may apply to you before you go to an SNF. Additionally, some services may require prior authorization from your insurance provider before they can be performed. If the prior authorization isn’t approved, then Medicare Part B won’t cover the cost of the service.

It’s also important to remember that if Medicare Part B doesn’t cover your SNF service, you may be able to use other private or public insurance options. You may even be able to get coverage through Medicaid if you meet certain eligibility requirements. Before selecting a health care plan, make sure to review all of the available options and compare the benefits and coverage each one provides.

Additional Insurance Options for Skilled Nursing Facility Care

If you need extended care for a Skilled Nursing Facility (SNF), there are additional insurance options that can help cover your costs. These policies can provide coverage for medical expenses not covered by Medicare Part B, such as:

Room and board for an extended hospital stay.
Prescription medication.
Medical equipment rentals.
Durable medical goods.
Rehabilitation and physical therapy.
Home health services.

In addition to traditional health insurance providers, there are many specialized companies that offer coverage specifically tailored to SNF care. These policies may include home health benefits, such as skilled nursing services or in-home medical equipment. They can also provide coverage for costs related to hospice care.

It’s important to shop around and compare different policies to find the best coverage for your needs. You should also consider discussing the available options with your healthcare provider or a local independent insurance agent.

Addressing Common Myths about Medicare Part B Coverage of SNF Services

It is important to understand what services are and are not covered by Medicare Part B when it comes to Skilled Nursing Facility (SNF) services. Unfortunately, there are several myths surrounding coverage of SNF services, which can lead to confusion and frustration.

Below are some of the common myths associated with Medicare Part B coverage of SNF services and the facts regarding these myths.

Myth: Medicare Part B covers all SNF services. Fact: Medicare Part B only covers certain types of SNF services, such as skilled nursing, physical therapy, and occupational therapy. It does not cover custodial care, long-term care, or hospice services.
Myth: Medicare Part B covers every visit to the SNF. Fact: Medicare Part B only covers a limited number of days each month and certain visits may require preauthorization. It is important to check with Medicare before planning any SNF services.
Myth: Medicare Part B and Medicare Part D have the same coverage for SNF services. Fact: Medicare Part B and Medicare Part D are two different plans that have different coverage rules. It is important to understand the differences between the two and the coverage that each offers for SNF services.

It is important to understand the truth behind Medicare Part B coverage for SNF services so that you can make informed decisions about your health care. Be sure to consult your local Medicare provider if you have any questions about what services are covered by Medicare Part B.

Summary

In this guide, we have explored the coverages provided by Medicare Part B for skilled nursing facility (SNF) services. We learned that Medicare Part B covers a range of SNF services such as skilled medical care, physical therapy and speech-language therapy, and more. Depending on the situation, additional costs associated with using an SNF, such as room and board, may be covered by Medicare Part B. Additionally, Medicare Part B has mandated coverage criteria for SNF services and there are some types of care and treatments that cannot be covered. Patients are also urged to explore Medicare Part D which provides supplemental coverage and additional insurance options for extended SNF care. Finally, readers should contact their local Medicare provider if they have any questions about Medicare Part B coverage of SNF services.