Understanding Medicare Part A

     Becoming a healthcare advocate for our aging loved ones may be necessary as their medical/health needs increase. It is important for family members to understand traditional Medicare benefits and coverage as well as the costs associated with both short term and long term care. Traditional Medicare Part A (hospital insurance) covers skilled nursing facility care under certain conditions and for a limited time. If your elderly loved one becomes ill or falls, for example, and is admitted to the hospital requiring skilled nursing care before returning home, there are a number of things to be aware of regarding Medicare Part A coverage.

     Skilled Nursing Facility (SNF) care is only covered by Medicare if:

     • You have Medicare Part A

     • You have a qualifying hospital stay (three overnight inpatient stays)

     • Your doctor ordered daily skilled care/rehab therapy services

     It’s very important to remember that the patient must be formally admitted as an “inpatient” to the hospital prior to coming to the nursing home, and must satisfy the three overnight stays. When a doctor orders “observation” services to help decide whether the patient needs to be admitted or discharged, this is considered outpatient and does not count toward your Medicare qualifying stay. Families must inquire about the admission status to determine if the following SNF care is covered by Medicare.

     Following a three overnight acute/inpatient care hospital stay, the first 20 days of skilled nursing home care are covered at 100 percent by Medicare. The next 80 days Medicare covers a portion of the daily rate as long as the individual is showing progress in their therapy. Medicare supplement insurance plans such as Blue Cross Blue Shield typically cover the remainder of the cost so the first 100 days are covered at 100 percent. If the patient doesn’t qualify under Medicare Part A, the individual may still receive rehabilitative services at the nursing home, however room and board is paid privately by the patient/family.

     To learn more about Medicare, contact your local skilled nursing facility, visit www.medicare.gov, or medicareadvocacy.org.