Managing Costs of Skilled Nursing

piggy bank and a stethoscope

Your patient requires skilled nursing care, but the family has no resources and is unsure how to cover the costs for it. What can you tell them?

Medicare Coverage of Skilled Nursing Care

Your patient must meet the following criteria before Medicare will cover their care in a skilled nursing facility:

  • They have Part A Medicare with days left in their benefit period.

  • They have a qualifying hospital stay, usually an inpatient hospital stay of 3 days or more within the past 30 days.

  • Your patient requires care by or care supervised by registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech-language pathologists or audiologists that may only be provided in a skilled nursing setting on an inpatient basis.

  • The skilled nursing facility is certified by Medicare.

  • Your patient’s skilled nursing care is required for an ongoing condition treated during their qualifying 3-day inpatient hospital stay (even if the condition wasn’t the reason for admission) or a new condition that began during previous skilled nursing care for the ongoing condition.

Skilled Nursing Services Covered by Medicare part A

Services covered by Medicare include:

  • Semi-private room
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Medications
  • Medical supplies and equipment used in the facility
  • Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services unavailable at the skilled nursing facility
  • Dietary counseling

Medicare does not pay for long-term care, although it will continue to pay for medical supplies and physician care.

Medicaid Coverage of Skilled Nursing Care

If your patient requires long-term skilled nursing care, it’s likely their family will turn to Medicaid for help. The law may require some patients to “spend down” their assets by paying out-of-pocket for care in order to qualify for Medicaid.

Not all skilled nursing facilities accept Medicaid, so if you’re in doubt about a patient’s ability to pay, make sure the one you choose does.

This article from Optalis experts will give your patients and their families an idea of how Medicaid works. This article will help them get a better picture of how to manage their assets if a family member needs long-term care.

If your patient has long-term care insurance, have them contact their insurance company to determine what it covers.

If you wish to refer a patient to an Optalis community or your patient is already at an Optalis community, this list of resources will prove helpful to you.