Short-term rehab programs are a fantastic way to help your loved one regain function and independence after an illness or injury. However, the situation can be fraught with stress and uncertainty when you don’t know how to pay for these programs. To help you with this issue, we share answers to four of the most common questions caregivers have about paying for short-term rehab.
Frequently Asked Questions About Short-Term Rehab
1. How do hospital-based and skilled nursing facility-based short-term rehab programs differ?
After a hospital stay, your loved one may be moved to either a hospital-based short-term rehab program or one located in a skilled nursing facility (SNF). Both programs have much in common. They all will provide physical, occupational, speech-language pathology therapy and social services and physician and nursing care.
Medicare covers both programs. The hospital in-patient program will be fully covered, but with particular Medicare-established goals regarding the length of stay.
With a SNF, Medicare requires that the patient has had a three-day qualifying hospital stay before admission. The first 20 days of care are fully covered.
Medicare coverage can be tough to understand, so we went more in-depth on this topic in a recent blog. Click here to learn more.
2. How much out of pocket costs will we need to pay for skilled nursing short term rehab?
If your loved one’s stay in a skilled nursing facility for short-term rehab extends beyond 20 days, a co-pay must be paid. In 2021, this payment will be $185.50 per day. However, many Medigap supplemental insurance policies and Medicare Advantage Plans will cover part or all of the co-pay. Medicare will continue to pay a portion of the skilled care short-term rehab for up to 100 days. On day 101, all Medicare payments cease.
3. If my parent experiences another injury or illness requiring short-term rehab, will Medicare cover it?
If your loved one experiences a health relapse or subsequent injury that requires the need for short-term rehab more than once, that care will be fully covered in a hospital-based program. With a skilled care-based program, however, coverage will depend on the timing of the second admission.
When discharge to readmission is less than 30 days, a new qualifying three-day hospital stay is required. Also, the recent admission to the SNF is considered part of the current benefits. This means that if the original admission was for ten days, your loved one still has ten days of full coverage before the co-pay is required. If the first admission was 20 days, the second admission would begin with a co-pay, and coverage will continue for 80 days.
If the time between the discharge and new admission to the skilled facility is at least 60 continuous days, the Medicare benefits renew, and your loved one will have the full 100 days of coverage (20 paid in full and 80 with the co-pay). Again, a three-day qualifying hospital stay is required.
4. What happens if my parent’s rehab is unsuccessful and must remain under nursing care?
Sometimes short-term rehab is not enough to help a senior recover enough to return home safely. At that time, your loved one will need to transfer from a skilled unit or hospital program to a long-term care residential program. These are private pay or Medicaid covered, with almost no Medicare payment support. Long-term care insurance, annuities, and reverse mortgages can help pay for these services. And if one or both of your parents were in the armed forces, veterans’ assistance and other financial aid programs may also be available.
Depending on the program and the length of stay, short-term rehab can be expensive for you and your loved one. Medicare and supplemental insurance will help with these costs, but you should discuss your parents’ various options before this service is required.
If your parent’s short-term rehab stay becomes long-term care, it’s also important to think beyond finances. This can be a difficult transition, so your loved one will need a lot of emotional support. Consider talking with your parent's primary doctor or nursing case manager about recommendations for a transitional living counselor, or contact your local Agency on Aging. Many senior services and faith-based programs exist to help your loved one work through the challenges associated with losing independence.
Likewise, sit down and discuss the situation with your loved one and other family members, as well as your parent’s care team and case manager. This conversation will keep everyone on the same page. During this meeting, discuss your loved one's condition, treatment progress to date, care plan, and revised recovery goals.
Short-Term Rehab at Marjorie P. Lee
At Marjorie P. Lee, our premier retirement community is designed to meet residents' needs over time. You or your loved one can live independently while enjoying the amenities of a senior living community, with the added confidence that our support services and staff are here to accommodate changes in your health and healthcare needs through our six levels of care — including short-term rehab, long-term care, and more.
Do you have more questions about paying for your parent’s short-term rehab? Fill out an information request form, and someone from our retirement community will be in touch soon.
Author’s Note: This blog was originally published on March 9, 2017, but has been updated and republished with new information.