Medicare doesn’t pay for 120 in a skilled nursing facility. They will pay for 21 days at 100 post if it’s for post hospitalization rehab. After that they only pay 80% so if your mom stays longer than 21 days and doesn’t have a supplemental then her SS check will go to the nursing home.
What she owes facility dependent on what type of entry she did.
Like if post hospitalization rehab patient, that’s MediCARE benefit @ 100% for 20/21 days & then if “progressing” up to 100 @ 80%. The 20% copay she owes (abt $170 day) has to be paid. If secondary insurer, like BCBS or better Medicare gap policy, usually covers 20% copay. But if not, her SS income can go towards the copay.
BUT and this is mucho importante.....
IF coming in as Long Term Care resident thats private pay, LTC insurance or applies for LTC Medicaid (& so is “Medicaid Pending”). If it’s LTC Medicaid, Medicaid requires her to do copay of basically all her monthly income (like SS$, retirement income, etc) as her copay or SOC (share of cost) to NH starting the date of filing her application. Must do SOC. Required compliance, comprende?
so which type is she? Most NH admits are post hospitalization rehab discharge to a NH after a 3 day hospital stay. Classic is broke a hip in fall at home, ER run, hospital admit, surgery & on day 4-5 discharged to NH for rehab. If this is you all, please please PLEASE use rehab stay to figure out ASAP where realistically she is going to live from here on out. & if she has a home, debts, car, etc. just what is best for all to deal with those & do whatever’s while she’s still on MediCARE coverage. Most do not get beyond 20/21 initial period. They are not able to progress in PT, OT, etc by day 17/18 so 86’d from rehab day 20.
Where are you getting “120” from? Its 100 max for MediCARE rehab is my understanding. Clearly ask SNF as to days coverage.
Most families are totally gobsmacked by the SOC requirements. You’re like the 4th SS$ & SOC posting in as many days on this forum. Dealing with the M&Ms (MediCARE & Medicaids) is a maddening maze. Good luck.
More info would be helpful...are you her financial Power of Attorney? Who is taking care of her affairs while she's in rehab? Are you asking about Medicaid? Please clarify so you can get the answers you need.
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Like if post hospitalization rehab patient, that’s MediCARE benefit @ 100% for 20/21 days & then if “progressing” up to 100 @ 80%. The 20% copay she owes (abt $170 day) has to be paid. If secondary insurer, like BCBS or better Medicare gap policy, usually covers 20% copay. But if not, her SS income can go towards the copay.
BUT and this is mucho importante.....
IF coming in as Long Term Care resident thats private pay, LTC insurance or applies for LTC Medicaid (& so is “Medicaid Pending”). If it’s LTC Medicaid, Medicaid requires her to do copay of basically all her monthly income (like SS$, retirement income, etc) as her copay or SOC (share of cost) to NH starting the date of filing her application. Must do SOC. Required compliance, comprende?
so which type is she?
Most NH admits are post hospitalization rehab discharge to a NH after a 3 day hospital stay. Classic is broke a hip in fall at home, ER run, hospital admit, surgery & on day 4-5 discharged to NH for rehab. If this is you all, please please PLEASE use rehab stay to figure out ASAP where realistically she is going to live from here on out. & if she has a home, debts, car, etc. just what is best for all to deal with those & do whatever’s while she’s still on MediCARE coverage. Most do not get beyond 20/21 initial period. They are not able to progress in PT, OT, etc by day 17/18 so 86’d from rehab day 20.
Where are you getting “120” from? Its 100 max for MediCARE rehab is my understanding. Clearly ask SNF as to days coverage.
Most families are totally gobsmacked by the SOC requirements.
You’re like the 4th SS$ & SOC posting in as many days on this forum. Dealing with the M&Ms (MediCARE & Medicaids) is a maddening maze. Good luck.
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