Original Fee-For-Service Medicare: How To Maximize Use

Medicare has strict rules on the coverage of care in a Skilled Nursing Facility and limits on how long they will pay for such care. See Medicare: Schedule of Benefits.  To help determine which skilled nursing facility works best for you, see Choosing a Nursing Home.

There are some things you can do at admission (or even earlier in discussions with your doctor about which Skilled Nursing Facility you will be moved to) that can keep your out-of-pocket costs to a minimum:

• Make sure the Skilled Nursing Facility has been approved by Medicare for use by Medicare beneficiaries.
• Ask your doctor to pre-certify your stay. This gives Medicare an advance look at your claim. More importantly, it gives you an advance idea of Medicare's willingness to pay your Skilled Nursing Facility claim.
• If you don't have written pre-certification from Medicare and there is any doubt about Medicare covering the charges, ask the Skilled Nursing Facility to submit a "demand bill" to Medicare. Medicare will send you a Medicare Summary Notice  explaining what will and won't be covered. If you disagree with Medicare's position, you may appeal by following the instructions on the Medicare Summary Notice. See Medicare: appealing the Claim.
• Clarify what personal items you will be expected to pay for.

Review the Medicare so you will know how many days Medicare will pay in full and how much you are expected to pay after that. See Medicare: Schedule of Benefits. 

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