Tag: medicare coverage

What does Medicare Cover in a Skilled Nursing Facility?

You or a family member have a serious health event like a stroke or a broken hip and are admitted to the hospital. Rehabilitation services are needed. What will Medicare cover?

Medicare will cover skilled nursing and rehabilitation services, that is medically necessary services ordered by a physician and performed by a physical therapist, occupational therapist or other skilled professional, under Medicare Part A.

To qualify for the coverage the patient must meet the following criteria:

  1. Patient must have been admitted to the hospital and spent three overnights. Important note: observation
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When Can a Resident of a Rehab Facility, Assisted Living or Nursing Home be Denied Medicare Coverage?

Medicare covers the cost of skilled nursing for twenty days and then eighty additional days on a co-payment basis for a total of one hundred days of coverage. However, sometimes a patient will be told by a facility that they do not qualify for skilled nursing under Medicare and that their benefits are being terminated early.

What is the appropriate standard for terminating coverage?

An important court decision was made in January 2013 in the Vermont case of Jimmo v. Sebelius. In that case, a lawsuit was settled between the Center for Medicare Advocacy (CMA) and Medicare contractors which dealt… Read the rest