What Will Insurance Cover for Skilled Nursing Services?
Navigating the need for increasing, varying and specialized forms of care for an aging loved one can be complicated. From increasing need for support in activities of daily living, to recovery after surgery and planning ahead after a progressive diagnosis – it helps to understand what options are available, when different resources are needed and what the financial picture looks like for each situation.
Many families discuss the option of moving to a senior care community, although the timing and circumstances are different for everyone. For families facing the need for short-term care or families who are facing the uncertainty of a major surgery or health recovery, it can be hard to know where to turn. A skilled nursing facility may be the answer; however, it helps to know what skilled nursing care means and how it can fit into the support model you need for your family.
What is a Skilled Nursing Facility?
Skilled nursing care is a high level of medical care provided by or under the supervision of a licensed health care professional. The services provided as part of skilled nursing are necessary over the short term to help the patient rehabilitate after a long illness, a serious injury or after surgery; these rehabilitation measures may also be needed by the patient on a long-term basis, depending on the individual circumstances and the patient’s overall health.
Some examples of skilled nursing services include things such as intravenous (IV) therapy, injections, wound care, catheter care, physical therapy and the monitoring of vital signs. Skilled nursing services can be provided at any facility with the equipment, trained staff members and other resources to necessary to serve the patient. At Charlton Place Rehabilitation and Health Care Center, residents have access to incredible health care and recovery tools, such as:
- Social services
- Exercise groups
- Physical therapy, speech therapy and occupational therapy
- Pain management
- Skilled nursing care
- Recreational programs
- Neurological care programs, including multiple sclerosis, stroke, amyotrophic and lateral sclerosis
Paying for Skilled Nursing Care
While many forms of senior care are out-of-pocket pay only, Medicare will pay for skilled nursing care in certain situations. Medicare Part A (hospital insurance) will cover skilled nursing care on a short-term basis if all these conditions are met:
- Your injury or illness requires a hospital stay.
- The initial hospital stay must last a minimum of three days.
- During the hospital stay, you must be classified as inpatient.
- Once discharged from the hospital, your doctor must order ongoing care.
- You have coverage for any conditions you develop while at a skilled nursing facility.
While Medicare Advantage does not cover long-term care, it may help to cover skilled nursing services. Medicare Advantage, also known as Medicare Part C, does cover skilled nursing care if certain conditions are met. Medicare Advantage will cover a stay in a skilled nursing facility for up to 100 days as long as:
- Care for a medical condition was treated during a three-day (or longer) hospital stay prior to the need for skilled nursing care.
- The skilled nursing facility is a Medicare-approved facility.
- Skilled nursing services are required on a daily basis and ordered by a doctor.
There are often multiple communities to choose from that provide skilled nursing services. It is important to select one that provides the type of care for your unique situation and one that offers the support and amenities that will set you up for a successful healing journey. At Coulterville Rehabilitation and Health Care Center, the specially trained team is committed to providing healthy living options and health care support. The programs at Coulterville Rehabilitation offer a therapeutic, holistic way of handling wellness. The team collaborates with your family and your primary care physician to create a personalized recovery and rehabilitation plan during your stay. That plan is designed to help you achieve your health goals, and it is carried out by licensed health care professionals.
If you require ongoing or long-term care in a skilled nursing facility, the expenses will need to be paid either out of pocket or with the support of programs outside of Medicare.
Tutera Senior Living and Health Care supports residents and their families throughout their aging journey. Tutera’s rehabilitation and skilled nursing communities maintain a focus on both recovery and personal preferences. Residency at a Tutera community begins with your YOUNITE Story – which is our way of collecting information about what you like, don’t like and your personal history. To optimize post-surgical rehabilitation, Tutera communities offer Lotus, a holistic wellness program with serene settings for recovery, personal development and healing. Our care is designed to get you back on your feet feeling strong and independent!
Contact Tutera today to learn more about our rehabilitation and skilled nursing programs by calling 877-988-8372. Ready to find a Tutera community near you? Follow the link to learn more about our locations.
Learn more by clicking on the community links below:
Bethany Rehabilitation & Health Care Center
Carlinville Rehabilitation & Health Care Center
Carnegie Village Senior Living Community
Charlton Place Rehabilitation & Health Care Center
Coulterville Rehabilitation & Health Care Center
Crystal Pines Rehabilitation & Health Care Center
Dixon Rehabilitation & Health Care Center
Fair Oaks Rehabilitation & Health Care Center
Hamilton Memorial Rehabilitation & Health Care Center
Highland Rehabilitation & Health Care Center
Hillsboro Rehabilitation & Health Care Center
Lakeland Rehabilitation & Health Care Center
Mattoon Rehabilitation & Health Care Center
Meridian Rehabilitation & Health Care Center
Metropolis Rehabilitation & Health Care Center
Monterey Park Rehabilitation & Health Care Center
Moweaqua Rehabilitation & Health Care Center
Norterre - The Estoria
Northland Rehabilitation & Health Care Center
St. Paul's Senior Community
Stratford Commons Rehabilitation & Health Care Center
Tiffany Springs Senior Living Community
The Village at Mission Senior Living Community
Willow Care Rehabilitation & Health Care Center