How Aspire Health’s Medicare Advantage plans help with hospital or SNF stays

June 20, 2022
Aspire Blog - How is a skilled nursing facility (SNF) different from a nursing home?

We recently wrote about how to avoid hospital readmissions, but what happens in the case of a stay in the hospital or skilled nursing facility (SNF)? When staying in a SNF, it’s good to know what kind of care you will receive and how Medicare can help you pay for it. We created this explanation to help people in Monterey County prepare.

What is a skilled nursing facility (SNF)?

Skilled nursing care and rehabilitation services are provided on a continuous, daily basis, in a SNF. The care you receive in a SNF is similar to the care you receive in a hospital and will be provided by nurses under a doctor’s supervision. As Medicare.gov explains, it’s healthcare given when you need skilled nursing therapy to treat, manage, and observe your condition. A stay in a SNF begins when a patient is recovering from an illness or injuries. The goal is to get you well enough to return home.

How is a skilled nursing facility (SNF) different from a nursing home?

The main difference between an SNF and a nursing home is how long you receive care. While skilled nursing care or therapy is temporary, care received at a nursing home is designed to be long-term. A nursing home provides residential care for people who aren’t able to live independently. Nursing home care is focused on daily living such as dressing, eating, bathing, and assistance with medications.

Does Medicare cover SNF stays?

Medicare Part A (hospital insurance) covers inpatient healthcare costs including hospital stays, SNFs, hospice care and home health care. Medicare Part A covers 100 days in SNF after a qualifying hospital stay. Part A deductible covers first 20 days per benefit period; after that, you pay part of the cost for each additional day of the stay- you would pay the full cost after 100 days. Note that long-term care such as nursing homes is not covered by Medicare. There is no monthly premium for Medicare Part A services. For more information on Medicare Part A, read our previous blog.

Visit Medicare.gov for more details about how Medicare Part A covers hospital stays, SNFs, hospice care and home health care. If you have any questions, contact Aspire Health Plan’s Member Services team at (855) 570-1600.

What do Medicare Advantage plans cover?

 Medicare Advantage (MA) plans (like Aspire Health Plan) cover everything that Original Medicare does, plus more. MA plans are offered by private, Medicare-approved insurance companies. They must include all of your Medicare Part A and Part B benefits, and they can offer additional benefits not included in Original Medicare including dental, vision and hearing along with other extras such as acupuncture, fitness programs, OTC allowance and transportation.

To enroll in an MA plan, you must sign up for Medicare Part A and Part B to be eligible, and you cannot enroll in both an MA and a MedSupp plan at the same time. Coverage varies by MA plan, so contact your plan directly for more information about coverage of SNF and hospital stays and specific benefit offerings.

How does Aspire Health Plan cover SNF and hospital stays?

It may seem like a stay in a SNF begins when you walk in the door and ends when you walk out, but that is not the case with Aspire Health Plan. Whether your stay began for a scheduled hospital procedure or from an emergency need, a stay in a SNF is a significant disruption to your life. Rarely can you expect to return to your normal self right away. That’s why with Aspire, your hospital or SNF stay begins when the need for it is identified (perhaps even weeks before the day you arrive) and ends when you are back to your optimal health status.

Recently, we began a new program to help you throughout that continuum — supplementing our nurse care management team with a new group of care-traffic controllers, known as “care guides.” Care guides are not clinical professionals, but rather highly trained experts in helping you navigate the demanding and confusing healthcare landscape. They make sure you’re fully prepared for your admission (when possible) and that your return home and transition to recovery go smoothly. Contact us for more information on working with a care guide.

We hope that this information is useful. If you have any questions about skilled nursing facilities or Aspires coverage, call Member Services at (855) 570-1600.

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