By Stan Cohen

A skilled nursing facility (SNF) is one that provides post-hospital extended care services at a lower level of care than provided in a hospital. A skilled nursing facility can be part of a nursing home or hospital. In order for Medicare to cover a skilled nursing facility stay, there are several requirements.

One of these is that the patient needs skilled nursing care seven days a week or skilled therapy services at least five days a week.  The care must be received at a facility that is Medicare-certified. Also, a doctor must verify that skilled care is needed and orders this service.

Ordinarily, people who have Original Medicare only qualify to get Medicare-covered SNF care if they have had three consecutive inpatient hospital days in the 30 days prior to admission in the Medicare-certified SNF. That qualification has been temporarily waived by the Center for Medicare and Medicaid Services (CMS) under certain conditions. People with a Medicare Advantage plan must follow the rules of their plan for coverage as they may be different than for Original Medicare. CMS, however, has liberalized some of those rules due to the need to help cover costs for COVID-19 patients. 

When people meet all requirements, Part A of Original Medicare pays the full cost of their first 20 days of care in a SNF each benefit period. In 2020, the daily co-pay after the first 20 days is $176. CMS has extended some other  SNF Part A benefits during the current crisis.

Medicare Supplement plans (except plans A & B) cover the SNF co-pay at some level. A benefit period begins the day you start getting inpatient care and ends when you’ve been out of the hospital or skilled nursing facility for 60 days. Medicare does not pay for care in a skilled nursing facility if a person only needs personal or custodial care (like bathing or dressing).

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