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I've never heard of paying day-to-day for rehab/nursing care.
You can pay week-to-week though.
You'll have to request a written bill though. Care facilities don't like to do this because they bill by the month and sometimes a month ahead. This means if they get paid up and the person is only there for a week, they keep the money.
Request to be billed weekly.
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Isthisrealyreal May 27, 2021
My dad was billed after his release, like 60 days later, for 2 days that his insurance didn't cover. I think that is the way to go if you can.
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NH told us Dad was being discharged on a certain date because he was unable to participate in rehab. He could not go back to where he was living and I could not get him moved into a new place by that date, so I did pay for him to stay an extra 2 days (you would have thought they could have worked with me) while I appealed his discharge. During that time he had a stroke and died.
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Isthisrealyreal May 27, 2021
I am so sorry for your loss.

I pray that you are doing okay and that you have received grieving mercies and comfort during this difficult situation.
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Funny story about rehab. After my husband broke his hip and needed rehab, we tried to get his Medicare Advantage plan to pay for at least a few weeks in a nursing home with acute rehab. They balked, and we were told they would pay for outpatient therapy but not inpatient. Husband really didn't need to remain in the hospital so he transferred to the rehab place while we appealed. We had to pay a big chunk of money upfront (self pay), but the therapies would have been covered by the Advantage plan because they would be billed as outpatient! As it turned out, once the facility sent materials supporting our appeal, we were successful within a couple of days and got back the money we'd paid them upfront. (I think the folks in the hospital making the referral just hadn't done a good enough job in making the case for the need for inpatient rehab.)

If your mom doesn't qualify for inpatient therapy but could be eligible for outpatient, I'm wondering if you folks could do something similar--have her self pay for the room and board portion of the charges and have the facility bill Medicare for her therapies (PT, OT, etc.) as outpatient. On the other hand, if she truly isn't going to make enough progress to meet the goal of returning home, it's probably not worth spending the money.
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Yes, you can self pay. The nursing home won't turn down cash. Room rates and therapy are totally separate charges. If you still want to pay for therapy, beware, it is very expensive!
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Lauralou, I am so sorry for everything that you have faced in the past 5 years. Congratulations on beating the cancer.

I found that I had to be proactive in getting my dad more care paid for by his Medicare. Speak with the facility and find out if she is making daily progress and how she can remain until she can do certain things.

If she can not safely come home if she isn't mobile, that could mean that she has now bypassed your ability to care for her in your home. You can't risk your wellbeing trying to get her in and up and dressed if she can't do it.

Unfortunately our loved ones can fail pretty quickly at her age and changes happen overnight. Please don't feel bad if her care is now more than you can handle safely. You will still be her advocate and most importantly, you will be able to be her daughter again.

Will you come back and let us know how you worked it out? We learn from each other and your contribution is valuable. Thanx! HUGS!
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Group a ?……
Is it 20% or 50% that MediCARE will pay from day 21 - day 100 for in a facility post hospitalization rehab for 2021???
And is the $185 set rate for the day 21+ copay only if you r Original MediCARE & a gap?
But if your Advantage, it will totally depend on the wording in your specific Advantage plan; so Advantage may or may not have a fixed $185 copay.
&
has anyone gotten an Advantage plan that actually has a residential rehab facility that is “in network”? Not a rehab place that you go to & spend better part of a day getting rehab, but one that you can stay in for week or 10 days or so for rehab.
Thanks in advance for insights. Yeah I know it should be a discussion but it dies relate to this post.
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Stacy0122 May 25, 2021
Yes, the rehab we always deal with due to BCBS of MI is in network.
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As has been posted, your funds should not go into your Mother's care. If she has traditional Medicare (red, white and blue card) they will be the first 20 days of skilled nursing and/or rehab at 100%. After that they will pay 80% and the balance is paid either my your Mom's private funds or by her supplemental insurance if she has one. If she has a Medicare advantage program you will need to read the policy and call customer service because their rates and dates are totally different. The key ingredient in both cases is
*the patient has to be participating in rehab
*the therapist and doctor have declared that the patient is progressing and will need rehab to continue to improve.

Once the patient plateaus or stops participating all insurances will stop paying. At that point if Mom wants to continue rehab and has the funds she can definitely pay for the service. You can always call Medicare or your Medicare Advantage program to see if they have a separate coverage for in home rehab. I'm not sure how that works.
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She needs to pay. Not you. Costs for up to the 100 days are custodial and I think this year it is $185 per day. Afterwards the care could be upwards of 12 to 14 k a month. This is the reality that you cannot afford to pay for her. Your profile says you are disabled which may make an unsafe discharge for her and you. Once she spends done to a couple thousand, the social worker can assist with the Medicaid application.
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Isthisrealyreal May 25, 2021
Isn't the $185.00 the payment required after Medicare pays their portion?

Wouldn't it be more if Medicare quit paying anything at all?
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If she still shows need for continuing “rehab”, then rehab can continue.
This is what 97yroldmom is referring to & pls read the link she posted.

Basically the issue is that once they are notated in their chart by the therapists after 2-3/5 subsequent sessions as “not progressing” then Medicare will stop paying & the doctors orders for doing therapy will cancel. Medicare can pay up to 100 days for therapy as long as they are still progressing. The 20 day period at the beginning has Medicare paying 100%. But if they still need rehab beyond the 20, Medicare will pay but at 80% with the 20% either from their secondary insurer or private pay. But they have to have orders from a MD for the therapists to base a care plan on.

I’d suggest that you ASAP have a clear chat with the therapists - PT, OT, ST - and find out exactly where your family member is in their therapy plan and if still progressing. What usually happens is they get discharged from the hospital with a specific ICD code for their therapy plan. So maybe knee surgery has 24 sessions and measurements done every other session which is recorded in their chart and reported to MediCARE. If their chart is showing no progress, it’s going to be hard to disprove. And the insurers are not going to pay. You as dPOA can appeal MediCARE ruling, but once in their chart it’s hard to refute.

Seems what usually happens once they stop progressing is that they sequeway from being a “rehab patient” (Medicare & secondary insurance) to a “long term care resident” (Medicare, Medicaid or LTc insurance or private pay). And within their LTC resident plan they will likely get therapy - again will be PT, OT, sometimes ST - but it will not be done as rehabilitation but will be for “maintenance”. And MediCARE will pay for maintenance to some degree maybe twice a week. It usually shows up on the Medicare statements of service as “gait training” for PT time and “use of function” for OT time. Ask the PTs & OTs to explain how it works; they can - if you’re the DPOA and MPOA - show you the history and measurements taken so you can see for yourself what’s what.

Medicare rehab benefit pays like triple what Medicaid will pay per day for room&board. A NH with rehab unit / services will do whatever legitimately to keep a person there under rehab as it flat pays so much more. They are not going to stop rehab just because. If rehab has stopped its because they are not progressing and their chart show this ime.
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Medicare pays 100% the first 20 days. 21 to 100, 50%. If Mom has a good suppliment they may pay the balance. In my Moms instance she was responsible for $150 a day. Stay in rehab is based on how the person is progressing. If they plateau they will be discharged from rehab. This means PT has done all they could. Then a decision needs to be made. Does the patient need 24/7 care. If so, you then may need to consider Medicaid paying for the person's care if they don't have the money.
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notgoodenough May 24, 2021
Yes, you're correct, I had forgotten about the 50% paid by Medicare, thank you, JoAnn.
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Does your mom have a supplemental plan? If so, check with them...Medicare paid for my mom's 1st 20 days, then her supplemental plan (United Health Care) picked up the remaining days. The Rehab facility told me they (UHC) would pay day 31-100, should she need to be in there that long.
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Medicare will pay a portion after the 20 days but the problem will be if she is no longer making progress. They have guidelines they must follow. Speak to the social worker about her options for when she is no longer able to progress with the therapy.

https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf
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