Becoming hospitalized is a challenging situation —the goal is to become well with treatment for the condition, illness or injury, which brought you to being admitted in the first place. For these events, there is Medicare’s Part A, which provides insurance coverage for your in-patient admission to a hospital. This can be confusing, because not all treatment at a hospital is covered by Part A – most often, individuals are treated in an emergency room, or medical facility that provides care under outpatient conditions, which is covered by Part B of Medicare. The critical difference is the need to be admitted to the hospital, under the care of medical providers for the purpose of treating your specific condition. At times, this treatment continues under medical settings after being discharged from the hospital. For these events, you may be transferred to a skilled nursing facility.
What is a skilled nursing facility (SNF)?
You may be transferred from a hospital to a location that provides competent medical treatment, progressive rehabilitative services and similar health services. This location may be called a nursing home, but the intent is a temporary stay by the patient, enough to resolve the medical condition that required in-patient hospital care in the first place. Medical professionals at a skilled nursing facility treat, manage, and observe your condition, and evaluate your care during your stay. Like a hospital setting, you will likely be provided a semi-private room along with meals while you continue to be treated, but the reason(s) for your stay do not need to have the full medical treatment capability of a hospital.
Medicare normally will only cover care you get in a SNF if you first have a “qualifying inpatient hospital stay.” This means a prior medically necessary inpatient hospital stay of at least three days in a row (starting the day you were admitted as an inpatient but not including the day you leave the hospital). Time you spend at the hospital under observation or in the emergency room before you're admitted doesn't count toward the three-day qualifying inpatient hospital stay, even if you're there overnight. If you don’t meet the three-day requirement, you may request a waiver, or you may be able to have your medical treatment continue in-home health care. If you have a trusted family member or friend helping you with your appeal, you can appoint them as a representative. Additionally, you may call our office for guidance.
Inpatient care and the benefit period
When you are hospitalized and/or receive skilled nursing facility care, Medicare measures your coverage in benefit periods, which are related to the number of days in a row you receive care. Each time you start a new benefit period you will pay the Part A deductible of $1,736 in 2026 before Medicare starts to pay. You don’t have to pay the Part A deductible for skilled nursing facility care if you already paid the deductible for care you received in a hospital during the same benefit period. You may also have Medicare Supplement Insurance (or Medigap) coverage which pays for some (or all) of this deductible. Similarly, if you have other secondary insurance coverage, check to find out what this provider will pay once Medicare has processed the claim. During a benefit period, what you pay after the deductible depends on how long you’re receiving skilled nursing facility care:
For the first 20 days, Medicare will pay the full amount.
From day 21 through day 100, you pay $217 for each subsequent day; you may have Medigap coverage (or secondary insurance) which pays some (or all) of these daily charges.
After the one hundredth day, you will pay all costs.
Your benefit period ends when you stop getting skilled nursing facility care for 60 days in a row. If you’re re-admitted to the hospital and/or a SNF from the sixty-first 61 day or beyond, a new benefit period will start. You must pay the Part A deductible each time you start a new benefit period. This could be multiple times in a calendar year (January–December).
There is little doubt that you may feel overwhelmed by either a hospital stay and/or a stay which followed by the transfer to a skilled nursing facility. For any question relating to this or for any Medicare related questions, please feel free to contact the State of Alaska Medicare Information Office at (800) 478-6065 or (907) 269-3680; our office is also known as the State health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers (MIPPA) program. If you are part of an agency or organization that assists Seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our Ambassador program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor for the Alaska Medicare Information Office.
