Medicare and Insurance Coverage


Medicare

Medicare covers skilled care in a skilled nursing facility (SNF) when you meet skilled criteria. "Skilled care" is defined as care that requires licensed skilled nursing or rehabilitation staff to manage, observe and evaluate your care. Medicare covers certain skilled care services that are needed daily on a short-term basis (up to 100 days).

Medicare will cover skilled care only if all of the following conditions are met:

  1. You have Medicare Part A (Hospital Insurance) and have days left in your benefit period to use.
  2. You have a qualifying hospital stay. This means an inpatient hospital stay of three consecutive days or more, not including the day you leave the hospital. You must enter the SNF within 30 days of leaving the hospital. After you leave the SNF, if you re-enter the same or another SNF within 30 days, you don't need another three-day qualifying hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start receiving skilled care again within 30 days.
  3. Your doctor has decided that you need daily skilled care. It must be given by, or under the direct supervision of, skilled nursing or rehabilitation staff.
  4. You need these skilled services for a medical condition.

You pay the amounts below for each benefit period:

Days 1 - 20: $0 for each day.
Days 21 -100: Co-insurance determined by Medicare on an annual basis. Please inquire with our admissions office.
Days over 101: You pay 100%.

Benefit Periods
A benefit period begins the day you enter a hospital or skilled nursing facility. The benefit period ends when you haven't received any hospital care (or skilled care in a SNF) for 60 consecutive days. If you go into the hospital after one benefit period has ended, a new benefit period begins.


Insurance

Burgess Square is an in-network provider of healthcare for the following insurance companies:

  • Beech Street
  • Blue Cross Blue Shield
  • CIGNA
  • Health Springs
  • HFN
  • Humana
  • Tricare
  • United Healthcare


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