How Will You Pay For Skilled Rehabilitation In The Nursing Home

One of the most frustrating events for individuals facing rehabilitation is thinking that their insurance is going to pay for everything and finding out that their insurance will not pay for the complete services required for a successful rehabilitation. Nursing home skilled units want to be assured that the necessary steps will be taken to assure that they will be paid. Nursing homes are most familiar with Original Medicare, Medicare Advantage Plans, Medicare Managed Care Plans, Medicare Preferred Provider Organization Plans, Medicare Private Fee-for-Service Plans, Medicare Specialty Plans, federal employee health program, military health program and railroad retirement programs. If your patient has one of these, they will be highly considered once that payer source is verified. Medicare Part A is the primary source of insurance that will pay for a skilled nursing home stay. Medicare pays 100% of day 1 through day 20 and from day 21 up to day 100 Medicare will pay everything less $114.00 per day co-pay as long as the resident is making progress towards their rehabilitation goals. If, Medicare is managed through a HMO (Health Management Organization) it usually pays 100% of the rehabilitation stay. The HMO determines the length of stay by the assessments provided to them by the nursing home rehabilitation staff and the level of independence required where the resident will reside after their rehabilitation stay. The HMO utilizes a Nurse Case Manager and a Medical Director who is a physician to make this determination. Secondary insurances with Medicare Supplemental Coverage will usually pay the $114.00 per day co-pay from day 21 through day 30 up to day 100 depending upon the tier level of the insurance plan and some tiers will some times pay up to 120 days. It is important for you to know what your insurance will cover. If you have the resources you can of course pay the Medicare $114.00 per day co-pay privately. Most states offer a Medicaid Program for individuals who meet the financial eligibility and medical need criteria. Please contact your State