Medicare Basics - Short Term Rehabilitation in a Skilled Facility

Q. Will Medicare A pay for my stay in a skilled long term care facility?

A. Yes, If you require further skilled care outside of a hospital setting, your Medicare will pay for everything, including medications for the first 20 days after a three day qualifying hospital stay. If you continue to qualify for skilled care, Medicare will continue partial payment for day 21 through 100 accompanied by a $128/day co-payment. This fee may be covered by supplemental insurance, Medicaid, and/or private funds.

Q. What is "skilled care" to qualify me for Medicare?

A. Skilled care is a more complex nursing care for people requiring IV therapy, physical therapy, occupational therapy, speech therapy, tube feedings, and/or complex dressing changes.

* Medicare benefits may also be utilized to cover terminal illness in a skilled facility instead of using Hospice.

Q. What happens after I no longer qualify for skilled Medicare?

A. Prior to your last day of Medicare coverage you will meet with the discharge planner to determine if you desire to return to your home or continue residing at the nursing facility. If you desire to return to your home the Discharge Planner will set up any home services you wish. These may include Meals on Wheels, Visiting Nurses or continued therapy at home to adjust back to daily independent living, LifeLine, and/or Housekeeping Services through agencies such as Community Care, etc . . . The services desired will be set up for you by the Discharge Planner.

Q. What if I need or choose to stay at the facility after my Medicare coverage ends?

A. Should your physical condition require permanent placement at a long term care facility or you desire to remain at the facility and not return home, requiring only intermediate care, Medicare will no longer cover room/board or medications. At that time the Business Office Manager or Discharge Planner will meet with you or your family to discuss payment options available for you. Your stay may either be covered at that time by private Long Term Care Insurance, Medicaid or private funds.

Q. What is "intermediate care"?

A. Intermediate Care is for people unable to stay by themselves. They may require assistance with medication or diet monitoring, nursing care for monitoring medical conditions or assistance with activities of daily living such as bathing, dressing, feeding, walking, etc.

Q. What is Medicare B coverage?

A. Medicare B coverage is for persons requiring skilled care such as therapy and/or wound care and who have not had a 3 day qualifying hospital stay for Medicare A. Medicare B may also be utilized to extend the length of therapy services once Medicare A benefits have been exhausted. Medicare B covers 80% of therapy treatments or wound care supplies, but does not cover room/board or medication costs. These costs may either be paid by Private Long Term Care Insurance, Medicaid, or private funds.