Admission into a rehabilitation or skilled nursing facility can be overwhelming. Usually it’s sudden and out of one’s control. In these situations, understanding Medicare and insurance coverage can be difficult. It is important to be educated on what you are entitled to under your insurance policies, so you can focus on healing and not stress over finances.
Our Business Office and Admissions Director work closely with patients’ insurance companies, and they explain to our patients and/or patients’ authorized representatives how their insurance will cover their stay at our facility. We accept Medicare A and B, Veteran’s Administration, Kaiser, Partnership Health Plan, and a variety of other managed care insurances. We can determine what secondary or supplemental insurances will cover and can offer advice on the policy benefits and restrictions.
Listed below are guidelines regarding Medicare coverage in skilled nursing. There are specific requirements that a patient must meet before admitting to our facility:
- A patient must have a three (3) day qualifying stay in the hospital. This means that the hospital must admit the patient, and the patient must stay for at least three (3) consecutive days in the hospital. If the patient is discharged home from the hospital, he or she has up to 30 days where he or she can be admitted to a skilled nursing facility.
- The patient’s doctor must order services that require one to be in a skilled nursing facility. These services include but are not limited to: a requirement for skills of professional personnel such as registered nurses, licensed practical nurses, physical therapy, occupational therapy, speech-language pathology, etc.
- A patient requires skilled care daily and the services must be ones that can only be provided in a skilled nursing facility.
- Individuals who are Medicare eligible have up to 100 days of Medicare coverage. However, once the resident reaches his or her baseline or has plateaued in rehabilitation, Medicare will no longer cover the resident’s stay.
- Days 1-20 Medicare covers a resident’s rehabilitation stay 100%; days 21-100 Medicare covers 80% of a resident’s stay. Beginning on day 21, there is a $164.50 a day co-pay incurred. There are secondary and supplemental insurances that cover this co-payment. Please ask our Admissions Director for details.
- Medicare will only cover short-term rehabilitation. Medicare does not cover long term/custodial nursing care.
The daily rate for skilled nursing care includes the following:
- Room and Board
- Three (3) meals per day and snacks
- Daily housekeeping services
- Administration of prescribed medication
- Assistance with feeding (if applicable)
- Social services
- Discharge planning
- 24-hour supervision by licensed nursing and certified nursing assistants
- Physician ordered special diets
- Bed and bathroom linens
- Drug regimen review
- Recreation and occupational programs
- Care planning
PLEASE NOTE OUR DAILY RATE DOES NOT INCLUDE THE FOLLOWING: PHYSICIAN VISITS, DENTAL VISITS, MEDICATION, MEDICAL SUPPLIES, INCONTINENT CARE SUPPLIES, SPECIAL PHYSICIAN ORDERED THERAPIES SUCH AS PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, RESPIRATORY THERAPY, DIAGNOSTIC TESTS, AND OTHER SPECIALIZED CARE PROCEDURES.