Bristol, Tennessee
Available by Appointment 10am-4pm
Medicare Part A provides benefits for SNF if certain requirements are met.
For many years facilities would apply the "Improvement Standard" however in Jimmo v Sebelius that changed. Medicare will cover skilled care provided in a skilled nursing facility, at home, or as outpatient therapy, regardless of whether a patient is likely to improve as long as they continue to meet qualifying criteria.
Medicare's coverage of a skilled nursing facilty stay is limited to a maximum of 100 days per benefit period.
The benefit period can sometimes be referred to as a spell of illness.
There is no limit to the number of benefit periods available to Medicare Beneficiaries. However, once a benefit period ends a beneficiary must have another three-day qualifying inpatient hospital state and meet the other requirements noted earlier before they can get another 100 days of SNF benefits.
If a person is released or no longer needs SNF but then later requires the SNF care again:
Medicare Part A does have a deductible that must be paid for any hospital admission and those rates can change from year to year. You can visit cms.gov to check the current Medicare Part A deductible.
Medicare pays for the first 20 days of skilled nursing facility care, with no deductible or coinsurance. However, the patient is responsible for daily co-payments after the twentieth day. For 2023, the daily SNF co-payment was $200 for days 21 through 100. After 100 days in a benefit period, the beneficiary must pay all costs.
Medicare Supplement plans, Medicare Advantage Plans, or Supplemental Hospitalization plans can help reduce these costs if you have one of those plans for an additional monthly premium.
Medicare will pay for home health care if a person meets certain eligibility criteria and if the services are considered resaonable and necessary for the treatment of the person's illness or injury.
Medicare covers home health care; it does not cover home care when personal care is the only type of care needed.
To receive Medicare-covered home healthcare benefits, a person must be eligible for and enrolled in Part A and/or Part B. The following requirements must also be met:
Home Health Aide Services:
Medical Social Services - Ordered by a doctor to help a person with various social and emotional concerns related to an illness that may interfere with the person's treatment or recovery.
Physical, Speech-Language, and Occupational Therapy - If ordered by a doctor.
Excluded Services:
There is no limit to the length of time that a person can receive home healthcare benefits. Once a person meets the initial qualifying criteria.
Recertification is required at least every 60 days when the patient needs continuing home healthcare.
Begining in 2019, CMS expanded the definitional scope of "supplemental benefits" that Medicare Advantage plans can offer. But all Medicare Advantage plans are not same as they may have different rules, costs, and restrictions on services but required to provide at least the same level of coverage as Original Medicare (Part A & B).
Additional Services that may be included with your Medicare Advantage plan:
Adult Day Care Services - services provided outside the home, such as assistance with activities of daily living and instrumental activities of daily living.
In-Home Support Services - services performed by a personal care attendance to assist disabled ormedically needy individuals with ADL's.
Home- Based Palliative Care - services not covered by Medicare in the home for palliative care ("comfort care") to diminish symptoms of a terminally ill enrollee with life expectancy of more than six months.
Transportation for (nonemergency) Medical Services - transportation to obtain Part A, Part B, Part D, and supplemental benefit items and services. It can not be used for non-medical services such as groceries and errand.
Home Safety Devices and Modification - safety devices to prevent injuries in the home an/or bathroom.
(423) 689-3061
Bristol, Tennessee
Licensed in:
Tennessee, Virginia, North Carolina, South Carolina, Georgia, & FLorida