When a non-ambulatory patient has plateaued and is moved from rehab bed to long-term bed in a care facility, what will Medicare pay for (if anything) and for how long?
The costs - after the Medicare's 100% / 80% rehab benefit is over - at a NH/SNF will be in 2 intertwined paths: room & board costs medical costs Medicare will NOT pay any of the room & board costs, but Medicaid will. Medical costs (MD fees, PT/OT, other therapists, Rx's) will be some combo of Medicaid & Medicare depending on what type of Medicare they are on, what your state's Medicaid program will pay. But one of the M&M's will be viewed as primary payment source. Often they will qualify for one of the medication/prescription "at need" programs and which M&M pays what co-pay will vary BY MONTH as some meds are done in 90 day packs and others 30 day so some months less $ for drugs. It is totally whack to keep track of. Really all you need to remember is that once she's on Medicaid and the NH accepts Medicaid & Medicare, all costs should be covered.
A thought for you…..If they should be in a NH and then qualify for hospice, that is a 100% Medicare paid benefit and Medicare will pay the hospice provider directly & as it's a Medicare benefit YOU (as dpoa for your mom) can select the hospice provider. Now the room & board will still needed to be paid & gets R & B billed to Medicaid. If your mom seems to not be doing well, I've really really REALLY try to get her evaluated for hospice so that when she moves from "rehab" to regular NH bed she is also on hospice. Hospice will mean that the hospice agency will come in to see mom anywhere from 2 -4 days a week and will provide staff that will essentially will be extra hands to help with mom's care. My mom was in a NH for 3 years with her last 18 mos on hospice at the NH as well. I've found the NH really just love love LOVE having hospice residents as hospice helps getting them bathed, linens changed, extra supplies or better nutritionals (like instead of Boost hospice got Twin Cal with probiotics for mom). A good NH will have a smallish group of hospice vendors that come to the NH and you can speak with them to find those that are a best fit for mom. The SW at the NH probably has good insight on what's what on options with the hospice groups that already come in. Ive found the SW are pretty frank and direct in speaking with families as they are required staff and somewhat independent of the personalties of the nursing staff and the DON (director of nursing & the power center at a NH). Medicare paid the hospice an average of $ 4,500 a mo for my mom for 18 months. Good luck on the transition!
room & board costs
medical costs
Medicare will NOT pay any of the room & board costs, but Medicaid will.
Medical costs (MD fees, PT/OT, other therapists, Rx's) will be some combo of Medicaid & Medicare depending on what type of Medicare they are on, what your state's Medicaid program will pay. But one of the M&M's will be viewed as primary payment source. Often they will qualify for one of the medication/prescription "at need" programs and which M&M pays what co-pay will vary BY MONTH as some meds are done in 90 day packs and others 30 day so some months less $ for drugs. It is totally whack to keep track of. Really all you need to remember is that once she's on Medicaid and the NH accepts Medicaid & Medicare, all costs should be covered.
A thought for you…..If they should be in a NH and then qualify for hospice, that is a 100% Medicare paid benefit and Medicare will pay the hospice provider directly & as it's a Medicare benefit YOU (as dpoa for your mom) can select the hospice provider. Now the room & board will still needed to be paid & gets R & B billed to Medicaid. If your mom seems to not be doing well, I've really really REALLY try to get her evaluated for hospice so that when she moves from "rehab" to regular NH bed she is also on hospice. Hospice will mean that the hospice agency will come in to see mom anywhere from 2 -4 days a week and will provide staff that will essentially will be extra hands to help with mom's care. My mom was in a NH for 3 years with her last 18 mos on hospice at the NH as well. I've found the NH really just love love LOVE having hospice residents as hospice helps getting them bathed, linens changed, extra supplies or better nutritionals (like instead of Boost hospice got Twin Cal with probiotics for mom). A good NH will have a smallish group of hospice vendors that come to the NH and you can speak with them to find those that are a best fit for mom. The SW at the NH probably has good insight on what's what on options with the hospice groups that already come in. Ive found the SW are pretty frank and direct in speaking with families as they are required staff and somewhat independent of the personalties of the nursing staff and the DON (director of nursing & the power center at a NH). Medicare paid the hospice an average of $ 4,500 a mo for my mom for 18 months.
Good luck on the transition!