Who Pays for Short Term Rehabilitation and/or Long Term Care?

Most people don’t think about how to pay for rehabilitation and/or skilled nursing care until the need arises.  When you visit one of our centers you can talk to an admissions coordinator.  He or she can help you determine your available long-term benefits. Here are some options:

     Medicare benefits are available to millions of Americans, including those over age 65 and some people under 65 who are disabled or suffer from permanent kidney failure.

     Long-Term Care plans usually pay based on a specified daily rate, which is usually detailed in the individual’s policy or handbook under Nursing Home or Skilled Nursing Benefits. Typically, these plans don’t pay for all of the services provided by the center. Any costs not covered by the Daily Rate would be considered Private Pay and are the responsibility of the patient.

     Another type of Long-Term Care coverage is Medicare Advantage Plans or Managed Care Plans.  Most of these plans pay based on Medicare Guidelines, but may have co-pays, deductibles and out-of-pocket limits that will have to be paid by the patient.

     Medicaid is an option for eligible, low-income patients in need of long-term nursing care. Eligibility requirements vary from state to state—we can help you determine if you qualify.

     The process of filing for Medicaid and receiving approval or denial can take as long as one to two months, depending on the accuracy and timeliness of the information provided. Each state usually has a website where application forms and a list of required information can be found. If you need help with forms, please contact us.

     Many insurance companies and employers now offer long-term care insurance.

Veterans’ benefits are available at some Nursing Homes through the Department of Veterans Affairs.

What Does Medicare Cover

For any eligible patient needing skilled nursing care, Medicare Part A coverage will pay for a semi-private room, nursing services, rehabilitation services, supplies and durable medical equipment for up to 100 days. Medicare covers 100 percent of skilled care the first twenty days in a nursing home. From Day 21 through 100, the patient must pay a daily co-insurance rate.

Patients who are eligible for the services covered under Medicare Part B will be responsible for an annual deductible plus 20 percent of the total charges for services, such as occupational, physical or speech therapy, plus medical supplies.

How do I know if my loved one qualifies for Medicare Part A Benefits

Your loved one must have a Medicare card that reads “Hospital Insurance” and must have spent a minimum of three consecutive days (not counting the day of discharge) in a hospital. The hospital stay must not have occurred more than 30 days prior to entering the rehab or nursing center.

In addition, a physician must certify that your loved one needs skilled nursing care on a continuing basis, and that the need for skilled nursing care must relate to the reason for hospitalization.

How do I begin my search and decision making on health care options for myself or a loved one?

Start with consulting your primary care physician. He or she will help determine the level and type of care required.

What are my payment options?

Most health care centers and practices offer payment through Medicare, Medicaid, Private Pay and Private Insurance.

Medicare is a health insurance program for people 65 or older. People under 65 may qualify with certain disabilities. Medicare does not cover all expenses and is not a long-term care payment option. Medicare covers short stays in hospitals and under 100 days in a health care center.

Medicaid provides medical benefits to low-income people with no medical insurance or inadequate coverage.

Private Pay is family or individual long-term care insurance and is not covered by a government program.

What are the different care options?

Respite Care: Temporary health centers care for dependents who are ill, handicapped or elderly to provide relief for their regular caregivers.

Assisted Living Care: Designed for those who want to retain their independence but may require some assistance with medications, bathing, dressing or meal preparation.

Short-Term Care (Sub Acute Care): For those recovering from illness, injury or surgery. Patients usually need additional medical and rehabilitative services before they can successfully transition from hospital to home.

Long-Term Care: For those that need medical supervision and daily living support that can no longer be provided at home.

Hospice: For those diagnosed with a life-limiting illness. Hospice provides medical, physical, emotional and spiritual support to patients and their families.

What should I look for when choosing a health care center?

Make sure the center offers the programs specific to you or your loved one’s heath care needs. Ask if 24-hour care is provided, look into the qualifications of the staff and research how often therapy is provided. Tour centers for cleanliness, friendliness and the amenities that may be important to you or your loved one. Sample food, visit with other patients, talk with staff and get a feel for the environment. Find out how involved family members may be and if it is encouraged.

If you have any additional questions associated with your search and/or about our centers, please do not hesitate to contact us. We are happy to help you find the right type of care for you or your loved one.