SNF: how much is covered?	When will Medicare cover skilled care?	Are there ways to get help paying for SNF?	What if I think I still need SNF?	
•	1-20 day = full
•	21-100 day = all but a daily copayment
•	beyond 100 days = nothing

*copayment is up to $109.50 per day
	Medicare will cover skilled care only if all of the following are true:
1. You have Medicare Part A* (Hospital Insurance) and have days left in your benefit period (see next page) available to use.
2. You have a qualifying hospital stay. This means an inpatient hospital stay of 3 consecutive days or more, not including the day you leave the hospital**. You must enter the SNF (Skilled
Nursing Facility) within 30 days of leaving the hospital (see 5 below). After you leave the SNF, if you re-enter the same or another SNF within a short period of time (generally 30 days),
you may not need another 3-day qualifying hospital stay to get additional SNF benefits (see 5 below). This is also true if you stop getting skilled care while in the SNF and then start getting
skilled care again within 30 days.
3. Your doctor has ordered the services you need for SNF skilled care, which require the skills of professional personnel such as registered nurses, licensed practical nurses, physical therapists,
occupational therapists, speech-language pathologists or audiologists, and are furnished by, or under the supervision, of these skilled personnel.
4. You must require the skilled care on a daily basis and the services must be ones that, as a practical matter, can only be provided in a SNF on an inpatient basis. If you are in a SNF for skilled
rehabilitation services only, your care is considered daily care even if the therapy services are offered just 5 or 6 days a week.
5. You need these skilled services for a medical condition that:
• was treated during a qualifying 3-day hospital stay, or
• started while you were getting SNF care for a medical condition that was treated during a qualifying 3-day hospital stay. For example, if you are in the SNF because you had a stroke, and you fall and break your leg, Medicare may cover rehabilitation for your broken leg even if you no longer need rehabilitation for the stroke.
6. The skilled services must be reasonable and necessary for the diagnosis or treatment of your condition.
7. You get these skilled services in a SNF that is certified by Medicare.
** Time you are being observed in a hospital before you are admitted doesn’t count toward the 3-day qualifying inpatient hospital stay.	Help from your state: If your income and assets are limited, you may be able to get help to pay for skilled and/or custodial care, or other health care costs. If you qualify for both Medicare and Medicaid, most health care costs are covered. You may also qualify for the Medicaid nursing home benefit or the Programs of All-inclusive Care for the
Elderly (PACE). Call your State Medical Assistance Office for more

Employer or Union Coverage: If you have coverage from an employer or union, check with your benefits administrator to see what health care is covered.

Medigap Policy: If you are in the Original Medicare Plan, you may have a Medigap policy to fill gaps in your coverage. Some
Medigap policies pay the SNF (Skilled Nursing Facility) coinsurance for days 21–100

Long-Term Care Insurance: If you have long-term care insurance, check your policy or call the insurance company to find out if skilled or custodial care is covered. If you are shopping for long-term care insurance, find out which types of long-term care services the different policies cover.

Reference:
The Official U.S. Government Site for People with Medicare
http://www.medicare.gov/
Accessed 9/15/05
	The SNF staff gives you a Notice of Medicare
Non-Coverage when they think you no longer qualify for Medicare coverage. But if you think that you still need SNF care, you have the right to have Medicare review the SNF’s opinion to decide if you still qualify for Medicare coverage.

To have Medicare decide if you still qualify for
SNF coverage
1. the SNF must send a special kind of claim to Medicare.  This special claim is sometimes called a Demand Bill.  Check off the appropriate box on the Notice of Non-Coverage to indicate that you want a Demand Bill sent to Medicare.

2. give the Notice to the SNF.

3. the SNF sends the special claim (Demand Bill)
to Medicare.

4. Medicare decides if you still qualify for
Medicare-covered SNF care.

5. the SNF will let you know what the decision is.

The SNF can’t make you pay a deposit for services that Medicare may not cover until Medicare makes its decision.  

You must continue to pay any costs that you would
normally have to pay while the Demand Bill is being processed. This includes the daily coinsurance and the costs for services and supplies not covered by Medicare. You will be responsible for the cost of the stay if Medicare determines you didn’t meet Medicare criteria.

You can file an appeal if you don’t agree with this decision.  To find out how to appeal, read the back of the Medicare Summary Notice or Notice of Utilization you get from the company that handles bills for Medicare.