Key Medicare Part A Criteria for Skilled Nursing Facility Coverage Explained

Medicare Part A coverage for skilled nursing facility (SNF) care is conditional on meeting specific criteria, including having a "qualifying" hospital stay. Covered facilities include acute care hospitals, critical care hospitals, inpatient rehabilitation, long-term care hospitals, and mental health care centers. To qualify for SNF coverage, beneficiaries must have Medicare Part A and require daily skilled nursing or therapy care under medical supervision at a Medicare-certified SNF. A critical requirement for coverage is a prior inpatient hospital stay of at least three midnights, which excludes observation stays or admissions shorter than three days. Medicare Part A covers up to 100 days in a SNF, with the first 20 days at full coverage. From day 21 to 100, beneficiaries have a daily copayment ($209.50 in 2024), and after day 100, they are responsible for the entire cost. This information is essential for healthcare providers, payers, and compliance officers to understand coverage parameters and manage patient care transitions and billing processes effectively.