Skilled Nursing Rehab and Medicare

Understanding how Skilled Nursing Rehab works and where Medicare fits in is extremely important.  There are a lot of facts that can affect your situation and create some serious issues for you if you or someone in your family needs this type of care.

The way Medicare handles Skilled Nursing Rehab is that the original Medicare plan pays 100% of the first 20 days.  Most of the time, if there is any improvement that the facility can say is enough improvement; Medicare will try to have you discharged within those first twenty days.

After the first 20 days, the Medicare beneficiary pays $128 and Medicare pays the remainder of the day’s bill for up to 100 days.  Looking at these figures, this is where supplemental insurance becomes very important.  This could be a Medigap/Medicare Supplement plan or it could be an employer retiree plan.  This type of plan will pay most or all of the $128 per day out-of-pocket expenses that are your responsibility. 

Because Medicare is a health insurance plan that provides medical benefits, in order to receive those benefits, they have to determine that there is a medical need.  If you are in a medical facility or skilled nursing rehab center, Medicare has determined the need, they will pay their share, however, when your condition improves, they will not continue to pay. 

Sometimes and individual or family does not agree with the decision that the person is ready to be released even though that person has improved. If that happens, it is important to very firmly and specifically relate your concerns to staff, the social worker, the doctor and the social worker.  If the person has had a stroke and is still unable to get in and out of the house safely, still have severe balance issues or other barriers, specifically let the facility and all the individuals we mentioned know.

Regardless, it is very important to study the issue of Skilled Nursing Rehab and Long Term Care very carefully.  Take the tie to do some research on the net, through your doctor and even at your local hospital and find out what good policies are available and how they work.  Be prepared so that if you or your family is ever in the situation where you need this type of coverage, you will be ready.

One Response to Skilled Nursing Rehab and Medicare

  • Josephine Thomas says:

    My husband was hospitalized 4 weeks in August followed by 5 weeks in a Rehab Nursing Home and received allowable medicare benefits. He was home for 3 weeks and doing well until he returned to the hospital emergency room on Oct.26 where he remained for 2 weeks and on November 8 was taken to a Rehab Skilled Nursing Home. My question is as to what medicare benefits he can now receive.

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