Follow
Share
I believe that traditional Medicare will cover medically needed./authorized rehab fully for the first 20 days in a benefit period. If the rehab is needed after day 20, Medicare will cover 80% of the cost and the patient (or hopefully their supplementary insurance) will cover the remaining 20%. This is all providing the patient is able and willing to participate in rehab. A person who can't or will not participate can be discharged from rehab. If the patient has no other skilled nursing needs, Medicare will inform the facility that they will no longer pay anything for the patient. At that time, the discharge social worker will have to arrange for a safe discharge. If no "safe" discharge can be arranged, the patient will have to apply to Medicaid which is the only insurance (outside of private long term ins) that will pay for long term care. Each state administers Medicaid slightly differently so you would need to check with the Medicaid Dept of the state in which the patient resides. In any event.... most states will do an interview regarding a financial "look back" of 2-5 years and a spend down of assets to about $2000.00. You would also need to supply major life documents such as birth certificates, marriage licenses, divorce papers, enlistment/discharge papers (veterans may be entitled so specific benefits and should check this with the VA), property deeds and mortgages, utility bills, bank statements, receipts for large purchases, etc.

Medicare Advantage programs have very different guidelines and you will need to carefully read their contract to see their monetary and time limitations.

If the skin infection has cleared up and she is "back to herself" I'm not sure why she is still there. I would speak to the Director or Nursing and request that she be discharged.
Helpful Answer (0)
Reply to geddyupgo
Report

Just read disgusted's reply. I would question the need for her to still be there. If she has been there a month, then she probably owes at the least 1500.

Just read your profile. Talk to the Director of Nursing and request that she be discharged. That there are people who live with her who can handle any care she needs. In home can be set up to check on the rash. She will be seeing her PCP. And if money is a problem, tell her that. Even if not, I would tell them she does not have the money to stay any longer. No, you do not want to apply for Medicaid. She wants to go home.

Rehabs are not prisons. But, they can't make an unsafe discharge. So comply to anything they suggest. We had one poster where all they had to do was prove they set up an aide. I told them to set up the aide, when LO got home then cancel it. There are no Rehab police. But they are a business. And they will milk Medicare and insurance as long as they can.

You may not want to go Against Medical Advice because they do not have to send you home with any prescriptions or set you up with in home care. But you can go AMA and just see her primary ASAP. He/she can set her up with what she may need.

You have me curious now so please update us on how this goes. Oh, if they still won't release her callyour State Ombudsman.
Helpful Answer (0)
Reply to JoAnn29
Report

Momheal, not when rehab is involved. That 80% is for regular medical bills. Hospital stays, doctors. Medicare pays 80% of what they feel is reasonable. The 20% is paid by the patient or their secondary insurance. And not all insurances pay that 20%. My Moms Medigap and my DH union BC/BS only paid half of the 20% Mom and I pay the other half. Its called a share fee.

Medicare pays 100% the first 20 days, 50% the 21st to the 100th day. The other 50% is paid by the patient or if lucky the secondary picks it up fully or partially. Its been 5 yrs but my Mom paid $150 a day for the time she was in over the 20 days. That mounts up.

As Mysteryshopper says you can be released for non-compliance. You have 3x you are allowed to turn down therapy.
Helpful Answer (1)
Reply to JoAnn29
Report
Cover66 Jun 24, 2021
Interesting. It was 80% after the 21 days and full cost after 100. 20% from day 21-100 was/is called CoInsurance.
(0)
Report
I thought it was Medicare paid 100% the first 20 days and then you or you secondary insurance pay 20% and Medicare pays 80% thereafter up to 100 days? I think I lucked out with moms secondary being an amazing plan that does not even exist anymore.
I do remember the hospital stay had to be “admitted” and not “observation” for 3 full nights in order to qualify for rehab.
Helpful Answer (0)
Reply to Momheal1
Report
Cover66 Jun 24, 2021
You're correct, after 100 days the patient pays the whole cost.
(1)
Report
From your profile:
"Her skin disease has since cleared up and we are trying to get her released, how do we legally get her released? She wants to come home and we have family that lives with her and takes care of her..."

Who is making her stay? Why are they making her stay? Or has it just not been discussed with her? If she's competent, she can request discharge. If she's not competent, her medical POA can request discharge.

You indicate she's been there a month and her issue has cleared up. Since that's over 20 days, there will be a bill. I would be rattling the admin cages to find out why they still have her there.
Helpful Answer (1)
Reply to disgustedtoo
Report
Cover66 Jun 24, 2021
Why they still have her there? Money
(0)
Report
Yes, it's true and it can be a nightmare if your lo is non compliant with therapy. You will get charged for every day after the 20th day. I don't know but it seems so unfair because each person is different and some get going quicker than others. My Mom got a bill from her rehab/assisted living for her extra days stay. They really think people are going to bounce back from broken bones and be up and about after a few ROM exercises. I also think they want the family members to be responsible for the rest of their so-called rehab. Ha.
Helpful Answer (2)
Reply to Rbuser1
Report
Cover66 Jun 24, 2021
Rehab still collects from Medicare after Day 20, what Rehab sends you is called CoInsurance, which can quickly add up, especially if there is no supplemental insurance to cover the cost.
(1)
Report
And the person must be participating fully in the rehab program. They must be able and willing to do everything they are asked in terms of exercises, etc unless there is a very, very good reason why they cannot do so. I observed a rehab lady request that the therapist come back tomorrow because she was "too tired" for therapy that particular day. She then requested assistance from the staff to change into a hospital gown and be put to bed. She acted like it was a vacation and she was calling the shots. Not so. Rehab is serious stuff. I'm sure that entire situation was documented and Medicare reviewed it. Whether the lady intended it to be the case, she technically refused therapy - which is the entire reason for being in rehab! She was discharged WELL before the max number of days, so be prepared for that as well. I think the woman may have thought she had months in the rehab and that may have contributed to her "come back tomorrow" attitude. Please remember that Medicare can discharge her with little notice and there's not a lot you can do about it. An appeal will get a short amount of additional time (like 2-3 days).
Helpful Answer (4)
Reply to Mysteryshopper
Report

Yes, and as explained. And that out of pocket mounts up if there the whole 100 days. A good financial officer will explain how it all works. TG Moms first stay in rehab I had a very good person. Second stay, I was home before I realized nothing was explained to me. Do not sign anything making you responsible for the bill unless ur the one getting the care.

Rehab does not cure. Their job is to try and get the person back to be as independent as possible. Sometimes that doesn't happen. A person will plateau. In the elderly an illness and a hospital stay can take a lot out of someone. Sometimes they never get back to who they were before the illness. Medicare determines when the person is discharged from the reports they receive.
Helpful Answer (4)
Reply to JoAnn29
Report

Yes, with very rare and short extensions. The problem is, unless you are old enough to understand Medicare and private insurance, staff at facilities keep others naive by not telling about it until a couple of days before those 20 days are up. They ask, what do you plan to do? The next step is a charge of about $185 (which increases each year) per day for the custodial care up to 100 days. That is about equivalent to assisted living care. If there is no improvement, then the care becomes nursing home type care at about $350 per day. Now you are educated.
You do not have to take the person home if the discharge is unsafe. Just tell them. The social worker should assist and advise family how to apply for Medicaid and start to liquidate any of the persons assets or real estate.
Some families are proactive months or years ahead and consult legal help to navigate.
Helpful Answer (2)
Reply to MACinCT
Report
Cover66 Jun 24, 2021
Faciliites don't have to tell the patient or family about how many days are left, that is left up to the patient and their family.
(0)
Report
They may cover longer if there is a crucial NEED to cover longer. They did in the instance of my brother because while in 21 days he had made all of the progress he was likely to make in OT and PT he did have some further wound care needs that " bought him more time". There has to be very good reason for an extension for medicare to cover it. That is up to the documentation of the doctors and nurses at the rehab.
Helpful Answer (0)
Reply to AlvaDeer
Report

It's complicated. Medicare covers 20 days in full if the patient is making progress.

They will cover another 80 days at 50% IF progress is being made.

This is after a qualifying hospital stay of at least 3 midnights of hospital admission NOT observation.
Helpful Answer (6)
Reply to BarbBrooklyn
Report
notgoodenough Jun 23, 2021
You are so correct Barb, and the hospital "stay: can be sneaky as well. You have to make sure you hear the words that your loved one is admitted. I have heard horror stories of people being in the hospital for days, but kept in "observation" status, which leads to nightmares as far as to what insurance covers and doesn't.
I learned to ask early on "my mom is being admitted, right?" and once I was told yes, I took down the name of the medical person who told me that, just in case.
(3)
Report
See 1 more reply
Ask a Question
Subscribe to
Our Newsletter