Rehabilitation

Payment Guidelines

Medicare guidelines set provisions for receiving Skilled Care. According to those guidelines, Skilled Care must end at 100 days or when the resident stops showing marked improvement as a result of receiving daily therapeutic treatments.

Skilled Care is paid through Medicare, Health Maintenance Organizations (HMOs) and/or private insurance. Costs may include:

• Daily room and board
• Utilities
• Medications and medical supplies
• Personal care products
• Medical equipment
• Therapy staff

If Skilled Care is completed but it is still not appropriate for the resident to return home or to their previous circumstances, other levels of care are available. These include Long Term care, assisted living, residential care or adult foster homes.

Medicare

Under a few limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who need skilled nursing or rehabilitation services. To be covered, you have to receive services from a Medicare certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay is the amount of time spent in a hospital just prior to entering a nursing home. This is at least three days. To learn more about Medicare payment for skilled nursing home costs, contact your Medicare Fiscal Intermediary or the State Health Insurance Assistance Program (SHIP) in your State.

 

Medicaid

Medicaid is a State program that will pay most costs for people with limited income and assets. Eligibility varies by State. Check your State's requirements to learn if you are eligible. Medicaid will pay only for nursing home care provided in a facility certified by the government to provide service to Medicaid recipients. For more information about Medicaid payments, call the SHIP for your State or call your State's Medicaid office. The telephone number is in the blue pages of the phone book.

Medicare Supplemental Insurance

This is private insurance—sometimes called Medigap because it helps pay for gaps in Medicare coverage such as deductibles and co-insurances. Most Medigap plans will help pay for skilled nursing care, but only when that care is covered by Medicare. Some people use employer group health plans or long-term care insurance to help cover nursing home costs.

Personal Resources

About half of all nursing home residents pay nursing home costs out of their own savings. After these savings and other resources are spent, many people who stay in nursing homes for long periods eventually become eligible for Medicaid.

Managed Care Plans

A nursing home must have a contact with your managed care plan in order for the facility to receive payment. If the home is approved by your plan learn if the plan also monitors the home for quality of nursing care.


Consult with your tax advisor for more specific information.