Medicare coverage for stays at sub-acute facilities can vary depending on several factors, including your specific medical needs and the services provided by the facility. Here are some general guidelines:
- Medicare Part A Coverage: Medicare Part A may cover your stay at a sub-acute facility if you meet certain criteria. This typically includes needing skilled nursing care or rehabilitation services following a hospital stay of at least three consecutive days (not counting the day of discharge).
- Coverage Duration: Medicare Part A coverage is generally limited to 100 days per benefit period for skilled nursing facility care, including stays at sub-acute facilities. However, coverage beyond the initial 20 days requires a daily coinsurance payment from days 21 to 100.
- Assessment of Medical Necessity: Medicare requires that your stay at the sub-acute facility be medically necessary and that you continue to require skilled care that can only be provided on an inpatient basis.
- Coverage Limits: Medicare does not cover long-term or custodial care, which is care that primarily helps with activities of daily living (such as bathing or dressing) rather than medical needs.
It’s essential to discuss your specific situation with your healthcare provider and the sub-acute facility to understand what Medicare will cover and any potential out-of-pocket costs. Additionally, confirm with Medicare directly or a Medicare counselor for the most accurate information regarding your coverage and benefits.