Does Medicare Cover Skilled Nursing Care?

The short answer: Yes, Medicare does cover skilled nursing care. Read further to learn about how skilled nursing care is defined, how Medicare covers it, and how it can impact you.

What Is Skilled Nursing Care?

Skilled nursing care is specialized care or treatment that can only be performed by licensed nurses.

While skilled nursing services are available in facilities such as hospitals, assisted living communities, life plan communities, and nursing homes, skilled nursing care should not be confused with nursing home or assisted living care.

Skilled Nursing Services

Physical therapy, occupational therapy, and speech therapy are all examples of skilled nursing care.

Skilled Nursing Staff

These services can only be performed by highly-trained medical professionals, hence the name “skilled nursing.” Examples of skilled nursing staff include:

• Registered nurses
• Licensed practical nurses
• Licensed vocational nurses
• Speech-language pathologists
• Audiologists
• Medical directors

How Does Medicare Cover Skilled Nursing Care?

Skilled nursing services are covered under Original Medicare. This means that any additional coverage you purchase—such as a Supplement or Medicare Advantage plan—also covers skilled nursing care by default. However, to be covered, your treatment must meet certain requirements set by Medicare.

Depending on whether you receive skilled nursing on an inpatient or outpatient basis, Medicare Part A and Part B cover your services.

Inpatient Skilled Nursing (Medicare Part A)

Medicare Part A covers inpatient skilled nursing care if you meet all of the following conditions.

• A skilled nursing facility provides your care on a short-term basis.
• You have Medicare Part A and remaining days in your benefit period.
• Your inpatient, qualifying hospital lasts at least three days.
• Your doctor has prescribed daily skilled care.
• You receive skilled nursing care in a Medicare-certified facility.

Preauthorization & Payment

The advisor team at RetireMed recommends that your provider preauthorizes these services in advance to ensure you are covered. For beneficiaries who are only on Original Medicare, your costs depend on the number of days left in your benefit period and how long you receive skilled nursing services.

• Days 1-20: $0 per benefit period.
• Days 21-100: $185.50 coinsurance per day in the benefit period.
• Days 101+: All costs.

Outpatient Skilled Nursing (Medicare Part B)

If you receive skilled nursing services in an outpatient setting, Medicare Part B picks up the cost. In that case, you can expect to pay 20 percent of the Medicare-approved amount.

With a Medicare Advantage or Supplement plan, you’ll pay a different amount based on the coverage you choose.

Questions About What Medicare Covers?

Reach out to our team for answers to all your Medicare questions. Call our advisors at 937.915.3563 or email advice@retiremed.com.

Already a RetireMed client? You can contact your advisor team by emailing client@retiremed.com or calling 877.222.1942.

Share this article: