What Caregivers Should Know About the Medicare Skilled Nursing Benefit

elder getting helpWhen an aging parent or senior loved one in Massachusetts is hospitalized or planning for a surgery, their physician may recommend follow-up care for a few weeks in a skilled nursing and rehab center. For many families, this is the first their first exposure to these type of care communities. Understanding what their Medicare benefit will and won’t cover is important in avoiding unexpected –and often significant - expenses. 

Understanding the Medicare Skilled Nursing & Rehab Benefit

This overview will help you understand Medicare’s basic requirements and coverage for seniors who need skilled nursing and rehabilitation after a hospital stay:

  • Three night hospital stay. For Medicare to pay for a skilled nursing and rehab center stay, the senior must meet what is known as the “three day rule.” It means they have spent three consecutive midnights at an inpatient level of care in the hospital. It is important to clarify that your loved one is in the hospital as an inpatient and not being cared for as an observation patient.
  • First 20 Days of Coverage. After your senior loved one moves to the skilled nursing and rehab center, Medicare will pay 100% of the first 20 days.
  • Days 21 – 100. Beginning on day 21, your aging loved one will be responsible for a co-payment amount of $152 per day (in 2014). If they have a secondary insurance, be sure to check with them to see if they will cover the co-pay. Many of them do. Medicare will pay the remaining amount up until day 100 if they continue to require skilled nursing and/or therapy services.
  • After day 100. Majority of older patients, who move to a skilled nursing and rehab center, complete their therapy before day 100. But if they don’t, they will be liable for the entire cost of the rehab stay after day 100.

If you have additional questions or would like advice on how to choose a care provider for your senior loved one, the Skilled Nursing Facility Checklist is a free tool you can download from Medicare.

We’re here to answer questions and help you make the best decision for care for you or your loved one. We invite you to reach out and talk with one of our care specialists at Fall River Jewish Home today! CALL 1.508.679.6172, where assistance is just a phone call away. 

Is there anything we missed? Please feel free to let us know below! 

 

    Post your comments...