Frequently Asked Questions

What is a skilled nursing facility?

A skilled nursing facility is a place where a person receives care from trained and licensed healthcare professionals to help them treat, improve, or manage a patient’s condition.

A person may need skilled nursing care after having an operation, such as a hip replacement, or after having had a stroke. Some of the services may include:

• Medication administration
• Occupational therapy
• Physical therapy
• Speech therapy
• Wound care

A qualified nursing home is not the same as a nursing home. The main difference is that a skilled nursing facility is usually not designed for a person to stay there indefinitely. A person stays in a qualified nursing care facility with the aim of improving their health and returning to their home or to a retirement home-type environment.

Does the insurance cover qualified nursing care facilities?

Health insurance policies outside of Medicare will often cover qualified nursing care facilities. The extent of this coverage depends on several factors such as:

• Your type of insurance policy
• Whether the skilled nursing facility is networked or off-network
• The type (s) of care you need

Some people choose to purchase a separate long-term care policy that can help supplement the costs of skilled nursing home care.

Does Medicare Cover Qualified Nursing Facilities?

Medicare covers a stay in a nursing facility qualified under Part A of Medicare, which pays for a hospital stay or hospital care at a qualified nursing facility. For Medicare to cover the stay in the facility, a doctor must certify that a person is in need of qualified nursing care. The person should also choose a Medicare-certified facility.

Medicare also sets a certain number of days that it will pay for skilled nursing care.

What are the reimbursable costs associated with qualified nursing facilities?

Medicare pays for qualified nursing home care by “indemnity period”. Whenever a person has a hospital stay and subsequent stay in a skilled nursing facility, Medicare will pay for up to a certain number of days. the expenses reimbursable through health insurance for a skilled nursing facility include:

• $ 0 for the first 20 days of a benefit period
• $ 185.50 coinsurance for days 21 to 100 of a benefit period
• All charges after day 100

A person can have more than one benefit period in a year. However, a person must go 60 days without inpatient hospital care or qualified nursing home care to enter a new benefit period.

What accreditations should I look for when selecting a qualified nursing facility?

Accreditation means that a facility has an independent body that evaluates its facility to confirm that it provides high quality care. There are several organizations that can grant accreditation to a qualified nursing facility. These include:

• Accreditation of aging services from the Rehabilitation Establishment Accreditation Commission (CARF)

• The Joint Commission, which offers a “Gold Seal of Approval” for qualified nursing facilities

If you are evaluating a qualified nursing facility, you can ask if it is accredited and what accreditation it has.

the Medicare website has a section called “Nursing Home Compare” which contains, among other information, reviews of qualified nursing facilities. You can rate facility sites based on complaint information, qualified nursing facility inspection, and facility quality metrics, which can help you choose the best facility for you or someone else. Dear. The site also rates facilities on a scale of 1 to 5 stars.

When Should You Consider a Qualified Nursing Facility?

Qualified nursing facilities are beneficial when a person needs rehabilitation, ranging from physiotherapy to occupational therapy. This often happens after a person has had a hospital stay due to surgery, injury, or a health event such as a stroke.

The alternative to a skilled nursing facility could be home care. However, qualified nursing staff can provide more in-depth service and 24-hour care. Usually, a doctor can help you determine which option is needed.

How long can you stay in a skilled nursing facility?

A stay in a qualified nursing home may be related to your general health and insurance coverage. The qualified nursing facility and your doctor should contact you if you require additional care. Often, insurance companies can continue to pay as long as a doctor re-certifies that care is still needed.

How we choose the best qualified nursing facilities

We looked at over 15 of the nation’s largest qualified nursing facility companies in the United States and looked at the range of services offered, insurance accepted, presence of programs designed to help residents return home, and awards and honors, if applicable. We have also given preference to qualified nursing facilities that operate in multiple states.