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My MIL is in rehab and over the 20 days. Reading conflicting things about whether or not Medicare pays for more than 20 days. She has her legs and ankles wrapped due to her injuries. She’s getting OT and PT because of cracks in both ankles and one knee from a fall. Is PT and OT considered Skilled Nursing Care and if so will Medicare pick up on 100 days of the rehab?


Read online that you should get the rehab to submit the bill to Medicare no matter what because when rehab submits the bill to Medicare they have to detail anything being done for her. Sounds like maybe it’s work they’d like to avoid if they can by just getting people to pay the bill! Anyone know anything about this Medicare coverage? TIA

When MIL was admitted who signed the papers? At that time she should have been told what the cost would be to her.

Medicare pays 100% for the first 20 days. 21 to 100 is 50%. After 100 days its private pay. Supplimentals pay some but there is usually a balance. For my Mom it was $150 a day. If the person can't afford the cost they may be able to get Medicaid to help. This is how billing works.

Rehabs send regular reports to Medicare. Based on these reports, Medicare determines if the person needs further care. If they determine that the person has hit a plateau, then they recommend discharge.

I have never heard of a rehab not billing Medicare to save paperwork. If they except Medicare, they must bill them.
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Reply to JoAnn29
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Everything you mention is correct. She has met the maximum payout from Medicare unless she gets readmitted after about 60 days or so. After 21 days the cost of care increases to around 160/ day roughly $5000/ month or the cost of private pay assisted living. If no progress at 100 days, someone will have to decide on nursing home or home with family members who will assume her custodial care and dressing changes. Medicare will only cover a few in home visits plus some OR and PT.

If she is still in care at 100 days consider that very little further progress will happen and long term care is next. Most of us will not recommend in home care due to stress, loss of wages, and risk of caregiver injury.
If the consideration is for long term care, you only have about 2 months to decide how to liquidate her home and belongings. Or start making Medicaid plans. Search for open beds that take Medicaid to get her in before funds are depleted. If you cannot get all in place, she will end up in any nursing home that has an opening no matter how good or poor. In some areas the next open bed could be 50 miles away.

Be proactive. Hope for the best but prepare for the worst. At 21 days you should have a family meeting. Ask the professionals if they feel she will ever go home on her own or if she needs help. Their answers should guide you. I recommend you find a book on Medicare and Medicade and hos to try and protect assets by Gabriel Heiser. A lot of libraries have it.
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Reply to MACinCT
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My mother is in Rehab now........I was told that Medicare will pay for 21 days of Rehab (as long as she's making progress with PT/OT) and then, if she needs more time in the Rehab facility, Medicare will pay 80% up to day 100, then nothing thereafter. I don't know if this is true or not, it's just what I was told. Also, there are different types of Medicare coverage, and they can differ quite a bit. For instance, my mother has a Blue Cross/Blue Shield Advantage PPO plan which is a lot worse than standard Medicare coverage, with lots more rules and hoops to jump through. So I'd say, check with your MILs insurance plan directly.
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Reply to lealonnie1
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JoAnn29 May 26, 2019
Medicare does not pay 80% it pays 50% starting thec21st day till 100 days. After that its private pay. Suppliment may pich up some of the cost but my Moms balance was $150 a day.
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Hopefully someone knowledgeable will be along soon, in the meantime I hope this helps a little:

https://www.agingcare.com/articles/medicare-coverage-of-skilled-nursing-facility-153265.htm
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Reply to cwillie
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