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St. Paul's Greenville

Medicare

You may be eligible for Medicare offered through federal or state programs.​

Medicare is a federal health insurance program. Medicare will pay for nursing home care provided several requirements are met. The patient must spend three consecutive days in the hospital — not counting the day of discharge — and must be admitted to a nursing home within 30 days after a hospital discharge.

Furthermore, the patient must be admitted to the nursing home for skilled care and receive care in a skilled nursing facility (SNF) for a condition that was treated in the hospital. Finally, the patient must be age 65 or older and have been employed long enough to be insured under Social Security, Railroad Retirement, or federal employment.

Examples of skilled services are overall management and evaluation of care plan, observation and assessment of the resident’s current health care needs or rehabilitative services on a daily basis, gastrostomy feedings, and/or therapeutic services.

Medicare benefits has two parts: A and B

Part A

Helps to cover for inpatient hospital care, home health care, hospice care, and care in a skilled nursing facility. It covers up to 100 days of care in a Medicare-certified SNF per “benefit period.” A “benefit period” begins day one of covered Medicare services and ends when the patient has been out of the hospital and has not received impatient skilled nursing facility care for 60 days consecutive.

Full coverage days 1-20: Medicare Part A covers all costs for SNF care. The coinsurance amount for days 21 thru 100 for 2023 is $200.00 per day.

Medicare Part A covers the following in a SNF:

  • a semi-private room
  • 24-hour nursing care
  • all meals
  • medication
  • medical supplies
  • medical equipment
  • therapy services from physical, speech, and occupational therapies

Part B

Helps to cover medical services and supplies that are not covered under Part A. Covers 80% of costs after the initial $226 yearly deductible.

If the above requirements are met, Medicare may pay for up to and not exceeding 100 days skilled care with 20 days of full coverage. In most cases, some co-insurance or supplemental may pay from day 21-100.