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Will Medicare pay for skilled nursing rehab that is doctor ordered?

An elderly relative has been ordered by his doctor to go directly to Skilled Nursing for Rehab prior to admittance to assisted living. He has not spent any time in the hospital & his health is such that he can no longer live alone even with in home health care. Will Medicare cover any portion of his Skilled Nursing for Rehab until a determination has been made whether he will have to stay in Skilled Nursing or has rehabbed to the point that he can enter assisted living. I understand Medicare will not pay for assisted living, but want to know if medicare will cover any portion of his time spent in rehab at the Skilled Nursing Facility.
Status: Open    Mar 02, 2015 - 01:31 PM


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Expert Answers

Mar 10, 2015 - 11:54 AM

This is the Medicare criteria for Skilled Nursing Rehab services

The most common name is Acute Care where people go if they have a health care issue where there is recovery from surgery, stroke, or rehabiliation from illness or accident which requires recovery.

1. Maximum number of days is 100 days of recovery
2. The first 20 days, Medicare pays expenses
3. On the 21st to 100 days of recovery -- there is a daily benefit of I think$157.00. It changes per day each year.
4. An important issue -- to go to an acute care facility you "must" be admitted to a hospital and then discharged after a minimum of 3 days of care. Should the hospital stay be observation or any admittance other then "you are admitted" to the hospital -- Medicare will not pay for acute services. Why? It has to be with payments to hospitals and the rules. That is why it is essential that you insist if you know a person will transfer to an acute care facility the status of their hospital admittance.
5. If you own Long Term Care Insurance, the benefits will help defer care giving expenses.
6. People who own LTC benefits may hire a licensed care giver to help them in a care facility where they will have personal attention.

Contact Medicare or an advisor if you want specifics. There is no point to say or complain...."it isn't fair" or "why won't they do...watever it is."

These are the rules because it is about money and who pays.

That is why knowing in advance about your options, knowing what to ask, and owning a LTC benefit will be of value to you, your family, your cash flow, and your committments towards the future.

Jul 23, 2015 - 12:56 PM

Medicare only covers rehabilitation in a skilled care setting following a qualifying hospital stay, namely a three or more day admitted stay. As your question is posed, there is no hospital stay and therefore Medicare will almost certainly not cover the rehab in this scenario.
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