Skilled nursing facility care

Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and evaluate your care.

Medicare-covered services in a skilled nursing facility (SNF) include, but aren't limited to:

• A semi-private room (a room you share with other patients)
• Meals
• Skilled nursing care
• Physical therapy (if needed to meet your health goal)
• Occupational therapy (if needed to meet your health goal)
• Speech-language pathology services (if they're needed to meet your health goal)
• Medical social services
• Medications
• Medical supplies and equipment used in the facility
• Ambulance transportation (when other transportation endangers your health) to the nearest supplier of needed services that aren’t available at the SNF
• Dietary counseling

Medicare will only cover care you get in a SNF if you first have a “ qualifying inpatient hospital stay. ” This means a prior medically necessary inpatient hospital stay of at least 3 days in a row (starting the day you were admitted as an inpatient, but not including the day you leave the hospital). What are some example situations?

Time you spend at the hospital under observation or in the emergency room before you're admitted doesn't count toward the 3-day qualifying inpatient hospital stay, even if you're there overnight. 
How do hospital observation services affect my SNF coverage?

If you don’t have a 3-day qualifying inpatient hospital stay and you need care after your discharge from a hospital, ask if you can get care in other settings (like home health care) or if any other programs (like Medicaid or Veterans’ benefits) can cover your SNF care.

You can appeal past hospital stays back to January 2009
If you’re a Medicare patient who was admitted to the hospital as an inpatient, and the hospital changed your status to “outpatient getting observation services,” you may be able to appeal the denial of Part A (Hospital Insurance) inpatient coverage that came from the change in your status. If your appeal is approved, Part A may cover the hospital and skilled nursing facility (SNF) services (if appealed) you got. 
Get more information on how to file this type of appeal.

You must meet all of these conditions:

• You have Part A and have days left in your benefit period to use.
• You have a qualifying inpatient hospital stay.
• You enter the SNF within a short time (generally 30 days) of leaving the hospital.
• Your doctor or other health care provider has decided that you need daily skilled care (like intravenous fluids/medications or physical therapy). You must get the care from, or under the supervision of, skilled nursing or therapy staff. What if I refuse daily skilled care or therapy?
• You get these skilled services in a Medicare-certified SNF.
• You need skilled services for one of these:
  • An ongoing condition that was also treated during your qualifying inpatient hospital stay (even if it wasn't the reason you were admitted to the hospital).
  • A new condition that started while you were getting SNF care for the ongoing condition.
• You need skilled nursing care or therapy to improve or maintain your current condition, or to prevent or delay it from getting worse.