Last Updated on January 3, 2025 by Frank Davis
When it comes to hospice care in a skilled nursing facility (SNF), many families have questions about how this care is funded. One of the most common inquiries is whether Medicare covers hospice services provided in an SNF. The short answer is yes, but there are specific conditions and guidelines that govern this coverage.
Medicare’s hospice benefit is designed to support individuals with a terminal illness who have a life expectancy of six months or less, as certified by a physician. This benefit provides a comprehensive set of services aimed at comfort and quality of life rather than curative treatment. These services include pain and symptom management, emotional and spiritual support, medications related to the terminal diagnosis, and assistance with activities of daily living.
How Medicare Covers Hospice Care in a Skilled Nursing Facility
Medicare pays for hospice care under Part A, the hospital insurance portion of the program. When a patient elects hospice care in a skilled nursing facility, Medicare covers the hospice services directly through a Medicare-certified hospice provider. The hospice provider receives a daily reimbursement rate from Medicare to cover the full range of services needed for the patient’s care. However, Medicare does not pay the skilled nursing facility itself for room and board. This distinction is crucial for families to understand.
What Does Medicare Cover in a Skilled Nursing Facility?
When a patient is in a skilled nursing facility and has elected hospice care, Medicare covers:
- Medical services provided by the hospice team: This includes visits from hospice nurses, social workers, chaplains, and aides.
- Medications related to the terminal illness: Pain relief and symptom management medications are included.
- Durable medical equipment (DME): Such as hospital beds, wheelchairs, and oxygen supplies, when needed for comfort.
- 24/7 on-call support: For emergencies or urgent symptom management.
What Isn’t Covered?
While Medicare covers the hospice services provided in an SNF, it does not pay for room and board unless specific conditions are met. For example, if the patient’s hospice care requires them to be in the SNF for short-term inpatient care to manage acute symptoms that cannot be managed at home, Medicare may cover those specific inpatient services. However, the daily cost of staying in the SNF, such as meals and lodging, is not included under the hospice benefit.
Families often need to explore alternative funding options for room and board in an SNF. This might include private pay, long-term care insurance, or Medicaid, depending on the patient’s financial situation and eligibility.
Medicaid as a Supplement
For patients who qualify, Medicaid may help cover the costs of room and board in a skilled nursing facility. Each state’s Medicaid program has its own rules, so it’s essential to check local regulations and eligibility criteria.
Navigating the Process
Understanding Medicare’s hospice benefit and its limitations is essential for making informed decisions. Families should work closely with the hospice provider and the skilled nursing facility to clarify coverage details and develop a care plan that meets their needs.
Hospice care in a skilled nursing facility can be a vital resource for patients and their families during a challenging time. While Medicare’s hospice benefit provides significant support, being aware of the nuances of coverage can help reduce stress and financial burdens. For further guidance, reach out to a Medicare-certified hospice provider like Hospice Valley, who can help navigate the complexities of end-of-life care planning.
