Today we will be discussing: Who is Eligible for a SNF:
People with Medicare are covered if they meet all the conditions listed:
1. You have Part A and have days left in your benefit period.
2. You have a qualifying hospital stay.
3. Your doctor has decided that you need daily skilled care given
by, or under the direct supervision of, skilled nursing or therapy
staff. If you’re in the SNF for skilled rehabilitation services only,
your care is considered daily care even if these therapy services
are offered just 5 or 6 days a week, as long as you need and get
the therapy services each day they’re offered.
4. You get these skilled services in a SNF that’s certified by
5.You need these skilled services for a medical condition that was
a. A hospital-related medical condition.
b. A condition that started while you were getting care in the
skilled nursing facility for a hospital-related medical
Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you’re getting observation services in the hospital, you’re considered an outpatient—you can’t count this time towards the 3- day inpatient hospital stay needed for Medicare to cover your SNF stay.
**Remember, any days you spend in a hospital as an outpatient (before you’re formally admitted as an inpatient based on the doctor’s order) aren’t counted as inpatient days. An inpatient stay begins on the day you’re formally admitted to a hospital with a doctor’s order. That’s your first inpatient day. The day of discharge doesn’t count as an inpatient day.
So how do you know if you’re an inpatient or an outpatient?
Your hospital status—whether you’re an inpatient or an outpatient—affects how much you pay for hospital services (like X-rays, drugs, and lab tests). Your hospital status may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay.
1. You’re an inpatient starting when you’re formally admitted to the hospital with a doctor’s order. The day before you’re discharged is your last inpatient day.
2. You’re an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient. In these cases, you’re an outpatient even if you spend the night in the hospital.
The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need 2 or more midnights of medically necessary hospital care. But, your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.
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