Medicare Advantage plans are private insurance plans that combine Original Medicare coverage and additional benefits, such as prescription drug coverage. They are sold by private insurance companies that are contracted with Medicare and can serve as an alternative to Original Medicare coverage.
Since these plans are required to provide the same coverage as Original Medicare, what is covered for skilled nursing care by Original Medicare will more than likely be covered by Medicare Advantage. However, do remember that your SNF benefits, choice of facility, costs, coverage, and rights and protections may be different with a Medicare Advantage plan. You will want to check with your specific plan for further information regarding how these things might be different and what that will mean for you.
Does Medicare Advantage Cover Skilled Nursing Care?
Skilled nursing facility (SNF) care is when you need health care that provides skilled nursing or therapy staff to treat, manage, observe, and evaluate your care. Under skilled nursing facility care, you can receive different types of treatments and services. These include: medical supplies and equipment, semi-private room, ambulance transportation, meals, physical therapy, occupational therapy, medication, and other covered treatments and services. Keep in mind that Medicare will not cover custodial care or long-term care, especially if that’s the only type of care you need.
You can receive covered skilled nursing facility care if:
- You had a qualifying hospital stay
- You need inpatient services from a skilled nursing facility and your doctor ordered it
- You need skilled care on a regular basis from a skilled nursing facility
- The skilled nursing services must be deemed medically necessary
- You receive those services from a skilled nursing facility that is Medicare-certified
If you currently have a Preferred Provider Organization (PPO) Plan and are trying to find a skilled nursing facility, you can go to any Medicare-certified SNF if a bed is available. Just keep in mind it could be less expensive by going to a SNF that’s in your plan’s network. If you have a Private Fee-for-Service (PFFS) Plan, you can go to any Medicare‑certified SNF if a bed is available, but you will need to let your plan know you need SNF care before being admitted to the SNF. If you have a Health Maintenance Organization (HMO) Plan, you may have to get your care from a SNF in your plan’s network. Make sure to contact your plan to see which skilled nursing facilities are in your plan’s network.
Call Us Today
If you currently have a Medicare Advantage plan but are still unsure of what coverage you can receive for skilled nursing care, you’ve come to the right place. At Game Changing Benefits, we’re here to help you find a Medicare plan that fits your coverage needs. For more information, give us a call today!