Medicare a Benefit

Medicare a Benefit

It has been determined that you are eligible for a Medicare A covered stay in a skilled nursing facility. To be covered under your Medicare A benefit, you must have a “skilled need”. You can f/u with your social worker or therapy for information regarding your specific “skilled need”.

This is a brief overview of how your benefit works when in a skilled nursing facility.

Medicare A benefits for a skilled nursing facility are based on a “spell of illness” or “benefit period”. The benefit period begins when you have a qualifying hospital stay & are discharged to a skilled nursing facility. The benefit period ends when you no longer require a “skilled level of care” as an inpatient in the facility.

The beneficiary is allotted 100 days of Medicare A coverage for a benefit period. If you have used days prior to this admission and have not had a “well period”, you will only have the number of days that were remaining from the 100 days of your previous stay. The first 20 days are covered 100% by Medicare, then days 21 through 100 are covered at 80%, with the beneficiary being responsible for the 20% co-pay.

At our facility, the average length of stay for short-term, sub-acute patients is 20 days. Although Medicare allocates 100 days per benefit period, that does not guarantee that all 100 days will or need to be used. A “skilled need” must be present, while making progress toward goals to remain covered under Medicare A.

You have used ______ benefit days prior to admission here without a “well period”. Upon your admission to this facility, you have _______ benefit days available under your Medicare A coverage. If you maintain a “skilled need” throughout your stay, your 100th day under Medicare A would be_________. This is subject to change based on any hospitalizations during your stay.

The cost of the 20% co-pay that the beneficiary is responsible for is $________ per day. You are expected to reach day 21 of your benefit period on...

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