• Tel (781) 344-2886
  • Email info@brc-law.com

Law Offices of Barry R. Crimmins

Barry Crimmins

  • Practice Areas
  • Firm Overview
    • News
  • Current Projects
  • Blog
  • Contact Us
    • Stoughton, MA
    • Hyannis, MA
    • Falmouth, MA
Slide background
Legal Expertise, Personally.
Attorney Barry R. Crimmins is someone that you can depend on personally.
We take a small town approach to our client relationships and carry that personal
commitment into all of our cases.
Slide background
Life Happens. We Help You Plan For It.
The many stages of life present a variety of legal implications. Guidance on
Estate Planning and Administration, Medicaid and Elder Law issues are our focus.
Slide background
Real Estate Transactions, Permitting and
Development.
Whether commercial or residential, we have extensive experience in all aspects
of real estate law.

Medicare's Different Treatment of the Two Main Post-Hospital Care Options

November 9, 2018 By Barry Crimmins

Hospital patients who need additional care after being discharged from the hospital are usually sent to either an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF). Although these facilities may look similar from the outside, Medicare offers very different coverage for each. While you may not have complete say in where you go after a hospital stay, understanding the difference between the two facilities can help you advocate for what you need and know what to expect with regard to Medicare coverage. 
 
An IRF can be either part of a hospital or a stand-alone facility that offers intensive physical and occupational therapy under the supervision of a doctor and nurses. IRFs offer a minimum of three hours a day of rehabilitation therapy. An SNF, on the other hand, provides full-time nursing care. Patients also receive physical and occupational therapy, but the care is generally less intensive and specialized than in an IRF. 

IRFs and Medicare

Medicare Part A covers a stay in an IRF in the same way it covers hospital stays. Medicare pays for 90 days of hospital care per “spell of illness,” plus an additional lifetime reserve of 60 days. A single “spell of illness” begins when the patient is admitted to a hospital or other covered facility, and ends when the patient has gone 60 days without being readmitted to a hospital or other facility. There is no limit on the number of spells of illness. However, the patient must satisfy a deductible before Medicare begins paying for treatment. This deductible, which changes annually, is $1,364 in 2019. 

After the deductible is satisfied, Medicare will pay for virtually all hospital charges during the first 60 days of a recipient's hospital stay. If the hospital stay extends beyond 60 days, the Medicare beneficiary begins shouldering more of the cost of his or her care. From day 61 through day 90, the patient pays a coinsurance of $341 a day in 2019. Beyond the 90th day, the patient begins to tap into his or her 60-day lifetime reserve. During hospital stays covered by these reserve days, beneficiaries must pay a coinsurance of $682 per day in 2019.  

To qualify for care in an IRF, you must need 24-hour access to a doctor and a nurse with experience in rehabilitation. You must also be able to handle three hours of therapy a day (although there can be exceptions). 

SNFs and Medicare

Medicare's coverage of skilled nursing care is more limited. Medicare Part A covers up to 100 days of “skilled nursing” care per spell of illness. Beginning on day 21 of the nursing home stay, there is a copayment equal to one-eighth of the initial hospital deductible ($170.50 a day in 2019). However, the conditions for obtaining Medicare coverage of a nursing home stay are quite stringent. Here are the main requirements:

  • The Medicare recipient must enter the nursing home no more than 30 days after a hospital stay (meaning admission as an inpatient; “observation status” does not count) that itself lasted for at least three days (not counting the day of discharge).
  • The care provided in the nursing home must be for the same condition that caused the hospitalization (or a condition medically related to it).
  • The patient must receive a “skilled” level of care in the nursing facility that cannot be provided at home or on an outpatient basis. In order to be considered “skilled,” nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse. Moreover, such care must be delivered on a daily basis. (Few nursing home residents receive this level of care.)

A new spell of illness can begin if the patient has not received skilled care, either in an SNF or in a hospital, for a period of 60 consecutive days. The patient can remain in the SNF and still qualify as long as he or she does not receive a skilled level of care during that 60 days.

Keep in mind that some or all of Medicare’s deductibles and co-payments for both IRF and SNF care may be covered by Medicare supplemental insurance, also called Medigap coverage.  

Filed Under: blogs

Contact Us Today

  • We are happy to discuss any legal concerns with you.
  • This field is for validation purposes and should be left unchanged.
Communication of information through this website does not create an attorney-client relationship.

Recent Posts

march newsletter

Elder Law News, March 2023

As the generation of Baby Boomers ages, many are finding their adult children aren’t in the financial position to provide support if long-term care is needed.

BRC Newsletter March

Elder Law News, September 2022

As the generation of Baby Boomers ages, many are finding their adult children aren’t in the financial position to provide support if long-term care is needed.

august newsletter

Elder Law News, August 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law News - May 2022 Thumbnail

Elder Law News, May 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law NEWS - April 2022

Elder Law News, April 2022

In 2022, change remains constant. But, as it applies to eldercare, some shifts are favorable, while others could directly impact the financial stability and level of care your loved one receives. 

Our expertise includes Real Estate Law and Land Use Permitting, Estate Planning and Estate Administration, with an emphasis on Elder Law and Medicaid Planning.
Practice Areas
We've developed a reputation for excellent service in these areas of the law through more than 35 years of experience.
Our Attorneys
The legal services from the Law Offices of Barry R. Crimmins, P.C. in Stoughton, Falmouth and Hyannis Massachusetts
Our Locations

Recent News

Law Offices of Barry R. Crimmins, PC

march newsletter

Elder Law News, March 2023

As the generation of Baby Boomers ages, many are finding their adult children aren’t in the financial position to provide support if long-term care is needed.

BRC Newsletter March

Elder Law News, September 2022

As the generation of Baby Boomers ages, many are finding their adult children aren’t in the financial position to provide support if long-term care is needed.

august newsletter

Elder Law News, August 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law News - May 2022 Thumbnail

Elder Law News, May 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law NEWS - April 2022

Elder Law News, April 2022

In 2022, change remains constant. But, as it applies to eldercare, some shifts are favorable, while others could directly impact the financial stability and level of care your loved one receives. 

Links

  • Home
  • News
  • Site map
  • Privacy Policy
  • Terms & Conditions

Contact Us

  • 909 Washington Street, Stoughton, MA 02072
  • 1436 Iyannough Road, Hyannis, MA 02601
  • 20 Academy Lane, Falmouth, MA 02540
  • Phone: (781) 344-2886
  • Email: info@brc-law.com

Follow Us:

  • facebook
  • twitter
  • linkedin

Estate Planning

  • Estate Planning
  • Estate Administration
  • Elder Law
  • Medicaid Planning

Real Estate

  • Land Use Permitting
  • Landlord – Tenant
  • Purchase & Sale Agreements
© Copyright 2023 Law Offices of Barry R. Crimmins, P.C. All rights reserved.
Site Maintained by Interactive Palette