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Medicare: Part A - Information for Skilled Nursing Benefit

  1. To qualify for your part A benefits in a Skilled Nursing Facility, you must have a three (3) night qualifying stay in a hospital prior to admission to a Skilled Nursing home. The hospital stay must have occurred within the last 30 days prior to the admission to the Skilled Nursing Facility.
  2. Once you have the qualifying stay, you are entitled (but not guaranteed) to 100 Medicare Part A days in the Skilled Nursing Facility. It is possible that you may not use all of your 100 days during that stay.
  3. Twenty (20) days of your 100 days are paid 100% by Medicare, day 21 through day 100 are paid at 80% by Medicare and 20% by the resident either privately or with supplemental insurance.
  4. Your 20% co-pay for day 21 through day 100 is $144.50 per day for 2012.
  5. If your condition improves and your Medicare is stopped before your 100 days are up, you can return to Part A benefits within thirty (30) days if you condition again declines.
  6. If you use your full 100 days, you must have a sixty(60) day consecutive “spell of wellness” (no hospital stays) in order to obtain a new 100 days.

Helpful Links

What is Institutional Care Program (ICP)

Institutional Care Program (ICP)

AHCA website (for finding facilities)

Facility Locator

Nursing Home Information

AHCA Nursing Home Guide

Info on Medicare

The information contained on this web page is for informational purposes only and is not be to used as a substitute for legal advice. Call our office for more information and a consultation.