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