Problem:

Ms. Z was a patient at a skilled nursing facility (SNF) for 100 days to treat a broken hip. She was discharged from the SNF after 100 days because she had run out of days in her benefit period. However, 20 days later she broke the other hip and was admitted to the hospital. She wants to know if Medicare would cover the SNF care she would need after she was discharged from the hospital.

What To Do:

Ms. Z asked a hospital Social Worker and learned that Medicare covers up to 100 days of care at a SNF during each benefit period (days 1-20 in a benefit period are covered in full by Medicare; days 21-100 are covered with a $164.50 per day in 2017). A benefit period is the way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. Ms. Z’s benefit period started the day she entered the hospital for the first broken hip and will end when she has not received Medicare-covered inpatient care at a hospital or SNF for 60 days in a row. Since Ms. Z has not been out of a hospital or SNF for 60 days in between her injuries, she does not qualify for a new benefit period. This means that Ms. Z will still be in the same benefit period for her second SNF stay for the other hip. Since she has already spent 100 days in a SNF during this benefit period, Medicare not cover anymore days in a SNF. Ms. Z will be responsible for the full cost of the additional time spent in the SNF unless she has another form of insurance to help pay those costs.

Because she cannot afford to pay out-of-pocket for the SNF care after 100 days, Ms. Z contacted Medicaid to find out if she qualifies for assistance.

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