What is required before Medicare Part A will pay for skilled nursing facility care?

Before Medicare Part A will cover skilled nursing facility care, a beneficiary must have a qualifying inpatient hospital stay of at least three consecutive days. This requirement ensures that individuals have received necessary medical treatment and are stabilized before moving to skilled nursing care, which is typically rehabilitation or additional treatment following a hospital stay.

This three-day inpatient stay is critical because it establishes the patient’s need for continuing care and allows Medicare to confirm that the skilled nursing facility services are necessary as a result of the condition that led to hospitalization. After fulfilling this requirement, Medicare will generally cover skilled nursing services if they are medically necessary and provided in an approved facility.

The other options do not align with Medicare's policies regarding skilled nursing facility coverage. A six-day stay is longer than what is required, leading to unnecessary hospitalization before transitioning to skilled care. A referral from a physician, while often beneficial, is not a prerequisite for payment under Medicare Part A, as the requirement focuses on the inpatient days alone. Additionally, having no prior hospitalization would preclude coverage under Medicare guidelines for skilled nursing facility care, as the prior hospital stay is essential.