Medicare Guidelines for Skilled Care

The Social Security Administration runs the Medicare program, a program that provides health insurance to people age 65 years or older or who have a long-term disability. Medicare is divided into four parts, and each part is divided into different types of coverage. Medicare provides hospital insurance, medical insurance, supplemental private insurance that includes hospital and medical coverage and prescription drug coverage.

Medicare

• The types of coverage that Medicare provides are known as Medicare Part A, Part B, Part C and Part D. Medicare Part A is free for individuals who have paid Medicare tax. If you want to enroll in other types of Medicare coverage, you must pay monthly premiums. Medicare Part A, which is hospital insurance coverage, includes in-patient care in hospitals and skilled nursing facilities, hospice care services and home health care services. To qualify to receive skilled nursing facility coverage, you must follow the guidelines established by the Social Security Administration.

Skilled Care Guidelines

• Skilled care is not the personal care you need to receive when you have a condition that impedes you from doing daily activities, such as bathing, dressing, eating, getting in or out of bed or a chair, moving around and using the bathroom. Skilled care is necessary medical care in a skilled nursing facility. Medicare covers skilled care for a short period of time, and only when you are in need of skilled nursing or rehabilitation so professionals can observe and evaluate your care and improvement. You can qualify to receive these coverage if, for example, you need intravenous injections and physical therapy.

Provider Guidelines

• You can only receive these services through Medicare from a skilled nursing facility that is certified by Medicare. This coverage in only available if you spend at least three days in a hospital right before you go to the skilled nursing facility. Your inpatient hospital stay starts only after a Medicare doctor approves it and you obtain a doctor's order for inpatient care. The three days do not include the day you are discharged.

Skilled Nursing Facility Care Guidelines

• If you are in need of skilled care and you are eligible to receive this coverage through Medicare, you must find an approved skilled nursing facility. If you do so, Medicare coverage for skilled care includes meals, a semi-private room, skilled nursing and rehabilitative services and other necessary services and supplies. Your need for skilled care must have a relation with your previous stay in the hospital.

Other Guidelines

• To be eligible to receive Medicare skilled care coverage, a Medicare-approved doctor must certify that you need skilled care and must give an order for it. Skilled care needs do not include long-term care or custodial care. Your need for skilled care is often a requirement to receive other Medicare services, such as ambulance services and coverage for room and board if you receive hospice care.