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Guest column by Martha Jones Sichko

Stroke, physical therapy or medical conditions are reasons why seniors may require a skilled Nursing Facility (SNF) after hospitalization. This article breaks down the elements of how Medicare works when needing skilled nursing, simplifying the maze of this critical service and making rehabilitation more understandable.

For original Medicare, the gateway to a SNF begins with a qualifying hospital stay requirement of at least three full, consecutive days. Note: Your discharge day doesn’t count. This initial “inpatient” requirement sets the stage for potential coverage from Medicare Part A for skilled nursing services, providing a financial safety net for eligible seniors. Currently, in Freeborn County, the Medicare Advantage plans don’t require a three-day inpatient stay and allow for 20 days for SNF rehabilitation. After the 20 days, the Medicare Advantage plans in our county will then levy a daily co-pay up to the out-of-pocket maximum.

A crucial step in unlocking Medicare coverage involves a doctor’s assessment and certification of the need for skilled nursing care on a daily basis. The importance of shared decision-making among the senior, physician and insurer cannot be overstated in this critical phase to ensure positive outcomes.

Medicare’s coverage includes such services as physical therapy, occupational therapy and speech-language pathology. These services must be deemed medically necessary and related to the senior’s hospitalization to ensure coverage.

Seniors can benefit from up to 100 days of Medicare coverage for a SNF, subject to assessments. Understanding the coverage nuances, such as the 20-day full coverage period and potential coinsurance beyond day 20, empowers seniors and their families to plan effectively.

With Ooriginal Medicare, here are 2024 SNF costs in each benefit period according to Medicare.gov:

• Days 1-20: Pay a $0 co-payment.

• Days 21- 100: Pay $204 co-payment daily.

• After day 100: Pay all costs.

Seniors with a Medicare supplement can offset some or all of these co-payments referenced above. Check plan documents to confirm.

Part A covers SNF coverage to 100 days in each benefit period. Your benefit period starts when you’re admitted to a hospital or SNF as an inpatient and ends 60 consecutive days after you leave without further inpatient care. If you return to the hospital within 60 days of your previous stay, you’ll still be in that benefit period. However, if readmitted after 60 days without care, a new benefit period begins.

Health care providers may suggest equipment and services not covered by Medicare. Inquire about necessity, cost and payment responsibility, as you want to be mindful of out-of-pocket expenses and co-payments.

Whether you receive Medicare directly from the government or an insurer, you’ve earned and deserve the best skilled nursing care.

Martha Jones Sichko is a senior advocate, helping to ensure affordable, accessible health care in Freeborn County.