If you need skilled nursing or rehabilitation for yourself or a loved one the cost of living at a facility can be quite intimidating. At Wesbury’s Grace Rehabilitation and Health Center we offer long-term care, rehabilitation with the goal of returning home, and memory support services. Before something happens to you or a loved one it is good to research and know what financial payment options are out there for you.
To be eligible for Medicare Part A coverage for rehabilitation, you must have had three overnight stays in an Acute Care Hospital and have a need for rehabilitation. If you are under “observation” at the hospital, Medicare will not pay for your stay at a facility.
Medicare provides coverage at 100% for the first 20 days. After that, if you are still receiving skilled care (therapies) there is a daily co-pay for the next 80 days, if you have a Supplemental Insurance Plan that covers this charge, it will be billed. If you do not have coverage, or your insurance denies payment you will be billed for these charges. Your Medicare coverage can be up to 100 days, but it is not guaranteed, your continued coverage is determined on medical and therapy criteria.
If, after your qualifying hospital stay you decide to return home, you have a 30 day window to still access your Medicare benefit. For example, if you have knee surgery – return home for a week and decide you want therapy at a facility – Medicare can still cover your stay as long as it is for the same condition you were admitted to the hospital for. Your physician would be involved and would determine if it is medically necessary for you to be admitted.
You can use Medicare for multiple rehabilitation stays as long as you have a 60 day period of wellness (a time period where you have not been in a hospital or receiving “skilled services”).
2.) Medicare Replacement Plans such as Highmark/Blue Cross, UPMC, AETNA, Humana
Medicare Replacement Plans can also provide coverage to those who need rehabilitative services. They do require pre-authorization prior to admission, Wesbury’s case managers work with the insurance company and/or hospital to obtain authorization. The coverage depends on your plan – please talk with your insurance representative to determine your coverage.
Please note: Medicare and/or Medicare Replacement Plans do not pay for long-term nursing care after being discharged from the rehabilitation program.
Medicaid is state and federal funding that can help pay for nursing home coverage if you qualify financially. Wesbury’s Billing department can help assist with this process and filling out the proper forms. There is a patient portion that you would be responsible for paying to the facility from your monthly income.
4.) Veterans Benefits
If you are a veteran, you may be eligible to receive Veteran’s Benefits. You will need to meet with your local veteran’s office to check eligibility.
5.) Long-term Care Insurance
Long-term Care Insurance is an insurance policy you can buy, which may pay for a number of days in a skilled facility, in-home care, respite stays, or enhanced living and personal care. Coverage amount and days of coverage is determined by the policy/coverage you purchased. Policies can vary in coverage and level of care.
6.) Private Pay
If paying privately out of your pocket for care, you would be responsible for the daily rate, plus any additional services you may require. Therapies would be billed to your Medicare Part B with 20% co-pay.