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Hospitalization, Skilled Nursing and Medicare

Recently, in one 48-hour period, I received similar questions from caregivers. These caregivers were not related, and they did not know one another. Each was the adult child whose parent was about to be discharged from a skilled nursing facility. Though they were very informed and had been through the hospital to skilled nursing to home process before, they were each a little unsure about their options, and wanted to be sure they did right by their parent. Their questions had to do with skilled nursing facilities, Medicare, covered days, and finally home health care options. It led me to lay out some of the information so that others could benefit. Below are the 2017 Medicare hospital and skilled nursing facility benefits. This information does not cover every aspect of the subject, but it is a start.

Medicare Part A Hospital Expenses*

Member Deductibles:

Members will have a $1316 deductible per benefit period. A benefit period starts the day you are admitted to a hospital or skilled nursing facility, and ends after you have not been in the hospital or SNF for 60 consecutive days.

Member Co-payments:

  • $0/day for days 1-60
  • $329/day for days 61-90 in hospital per benefit period.
  • $658/day for days 91-150 in hospital per benefit period (Lifetime Reserve Days).
  • No coverage after day 150 in hospital (or day 90 if Lifetime Reserve Days previously used).

Skilled Nursing Facility Expenses*

  • Full coverage of expenses in skilled nursing facility for days 1-20 when this follows a 3-day hospitalization during each benefit period.
  • $164.50/day for days 21-100 in a skilled nursing facility during each benefit period.
  • No coverage after day 100 in skilled nursing facility during each benefit period.

*Hospital and Skilled Nursing Facility daily co-pays may be covered by your Medigap policy or other commercial secondary insurance coverage.