Short-term care. What does that actually mean? How “short” is it? What facilities provide short-term care?

This article will help you understand what short-term care is and what coverage is provided in your Original Medicare benefits.

Short-Term Care: A Definition

Short-term care has a very defined outcome. For instance, short-term care can be provided in a skilled nursing facility (SNF) to observe, manage, or treat a condition.

This is common if an individual falls and is injured, requiring post-operative care, or is in need of IV therapy or injected medications.

Short-term care is overseen by a physician. Other providers may include RNs, speech therapists, physical therapists, etc.

These instances are considered short-term care, providing that they do not extend past 12 months (in most instances). Short-term care in SNFs is considered a transitory time between the hospital and permanent residence. For this reason, Medicare does provide some benefits for its members.

Medicare Benefits for Short-Term Care

When Benefits are Offered

Medicare Part A, your “hospital insurance,” offers some benefits for short-term care. However, you must meet certain criteria.

• You have not used all of the allotted days;
• You have a qualifying hospital stay;
• Your doctor orders short-term care by skilled staff;
• The SNF is Medicare-certified; AND
• The medical condition requiring short-term care began while you were in an SNF for a hospital-related condition OR it is due to a hospital-related condition that was treated during an inpatient stay.

What Short-Term Care Includes

A short-term care stay will be unique to the individual involved, but some of the services offered are:

• Skilled nursing
• Speech therapy
• Physical therapy
• Occupational therapy
• Semi-private room
• Meals and dietary counseling
• Ambulance transport
• Medically-related social services

Your Cost

Assuming that you have all of your allotted days left for the benefit period, your cost will be as follows:

• Day 1 – Day 20: $0
• Day 21 – Day 100: $185.50 per day
• Day 101 +: 100% out-of-pocket

*These costs are for 2021.

COVID-19 Amendment

Due to the hardship of the COVID-19 pandemic, there have been a couple of amendments to Medicare’s short-term care coverage.

First, if the member has used all of their allotted days, that member may be eligible for a renewal of days prior to the new benefit period.

Second, you are eligible for short-term care in a skilled nursing facility without first having a qualified hospital stay. 

Short-Term Care Outside of Medicare

Medigap Policies

Supplements to Original Medicare, Medigap policies can help pick up the costs of short-term care that Part A leaves behind. These policies are purchased through private insurance companies, so premiums, deductibles, and copays will vary.

Individual Short-Term Care Policies

Individual short-term care policies are available for those who need it. This is a common form of insurance chosen by those who have retired, but have not reached the age of 65 when they are eligible for Medicare benefits.

Like Medigap policies, these are purchased through private insurance companies, so premiums, deductibles, and copays will vary.

__________

This is a brief overview of what to expect with Medicare’s short-term care benefits. Medicare.gov has a very informative booklet that explains SNF care in more detail.

As always, John is here to help answer all of your Medicare and insurance questions! Call him at 801-637-4420