Short term rehab programs are a wonderful 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 are sharing answers to four of the most common questions caregivers have about paying for 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 as well as social services and physician and nursing care.
Both programs are covered by Medicare. The hospital in-patient program will be fully covered, but with very specific Medicare-established goals regarding length of stay. With a SNF, Medicare requires that the patient have had a 3 day qualifying hospital stay prior to admission. The first 20 days of care are fully covered.
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 2015, this payment is $157.50 per day. Many Medigap supplemental insurance policies and Medicare Advantage Plans, however, 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 mother experiences another injury or illness requiring short term rehab, will it be covered by Medicare?
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 the time from discharge to readmission is less than 30 days, a new qualifying 3 day hospital stay is required. Also, the new admission to the SNF is considered part of the current benefits. This means that if the original admission was for 10 days, your loved one still has 10 days of full coverage before the co-pay is required. If the first admission was for 20 days, the second admission will 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 3 day qualifying hospital stay is required.
4. What happens if my mother’s rehab is unsuccessful and she 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, veteran’s 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 the various options with your mother before this service is required.