How Does Medicare Work

Question: What is Skilled Nursing/Rehabilitation?

  • According to the Centers for Medicare and Medicaid Services (CMS):
    • Skilled care is health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. Examples of skilled care include intravenous injections and physical therapy. Medicare will only cover skilled care when you meet certain conditions.

Question: When and how long will Medicare cover Skilled Nursing Services/Rehabilitation?

  • Certain criteria have to be met before Medicare will cover under the Skilled Nursing Benefit...
    • You have a qualifying inpatient (not observation status) hospital stay of three (3) consecutive midnights
    • The skilled care is reasonable and necessary for diagnosing and treating your condition
    • You receive these services at a Skilled Nursing Facility certified by Medicare
  • If you meet the above criteria, you may qualify for up to 100 days of Skilled Nursing Services

Question: How much is covered by traditional Medicare?


Days Medicare Pays for covered services You pay for covered services
1 - 20 Full Cost Nothing
21-100 Everything beyond the daily co-payment Daily co-payment of $148.00*
Beyond 100 Nothing Full Cost

*this co-payment may be covered by your secondary insurance policy if you have one

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