He was in hospital for infection in knee which caused calf swelling . Medicare plus our supplemental plan covers up to 101 days. I’m guessing the amount we would have to pay out-of-pocket if he were discharged before 101 days would be considerably more than they would get from insurance. Am I being paranoid or does this sound fishy to anyone? Thank you.
If he requires therapy beyond 20 days and is progressing, Medicare will cover 50% and your supplemental insurance ( if you have) will cover the other 50%.
In other words, you are not guaranteed 100 days of rehab. And yes, you will only get 48 hours notice, so the facility wants you to have a plan ready, i.e., will he be going home (and is your house ready in terms of equipment, modifications, help) to another facility (start looking now) or will you need him admitted to their facility as a long term care patient.
They are very kind to give you a heads up about this from the outset. Many posters end up here in a panic because they get a call from rehab saying "we are discharging your Loved One tomorrow, what is your plan?"
To the extent possible, make sure your husband knows he can't blow therapy off and stay in rehab paid for by Medicare. He has to be participating and progressing.
As far as insurance I have seen many versions here so as with many insurances they all differ. My Moms supplement (or co-insurance) picked up her copay after the 20 days - it was a blessing. Reach out to your supplement and gather that information so it doesn’t come as a surprise.
Medicare will cover up to the 100 days (but only the first 20 days are covered 100%). Then there are assessment periods throughout the remaining coverage days (you are not guaranteed 100 days) - so he will have to meet “Medicare’s goals” to continue to receive therapy. The rehabilitation place and therapist must report to Medicare any gains made to continue to get approval for more rehabilitation (I don’t remember the exacts but you could ask the rehab - I believe my moms assessments were anywhere from 1-3 weeks) but they do differ so ask the rehab he is in now -as it will help you prepare that “every Friday is an assessment and you could get a call saying discharge planning has begun”. If he no longer makes gains and plateaus they will release him.
At this point you can request to go home with home health and additional therapies and nursing if he still has medical needs or go home and start outpatient rehab (so you could also start looking at home health agency’s and outpatient rehabs in your area now) so you have time to research them and have a few to choose from at discharge.
It is extremely overwhelming. If he has arrived at rehab - you should have a care plan meeting - you can ask many of these questions here.
Depending on your loved ones needs at discharge this care planner with be the one who helps you set up your in home plan. If you needed wheelchairs - beds - any other DME equipment such as commodes - walkers - home health - etc.
Breathe - and come back here for any questions and help with other resources. Wishing your loved one a speedy recovery.
If you are just in over your head, and who wouldn't be taking care of an Alzheimer patient by themselves. Please speak with the discharge planner and tell them that his coming home will no longer be a safe arrangement. They can direct you to resources to help you place your husband in a care facility that can meet his needs.
I highly recommended finding a certified elder law attorney (www.nelf.org) and asking for help to ensure that you are doing things to protect your financial well-being while ensuring that your husband gets the care he needs by a team of professionals.
You matter as much as he does and you can not continue this journey alone. Sometimes the most loving thing we can do for our loved one is to get them a village. You will still be present and caring for him, you just won't have everything on your shoulders.
Great big warm hug! Remember - breathe!
The good thing is, there is therapy available that your husband has as a benefit of his Medicare insurance policy Part A. There are reference points spelled out for that benefit that are important for you to know.
This link is helpful. https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care
You mention you have a supplement, that’s great. As Barb pointed out that will cover the 50% Medicare doesn’t after day 20. (Your supplement might have a deductible).
If your question is, would private pay be more than Medicare coverage, the best way to know is to ask the facility what the charge is for private pay at their facility.
Many times a loved one will want their caregiver to be with them while in the hospital and rehab. It’s important that someone is advocating for them, but it is equally important that the post 20 day care be arranged. Additionally a patient has to be onboard with the program. If they are not willing or able to participate, they will not be allowed to stay.
Things like the 48 hr notice can feel like a “gotcha” when you are worn out and not prepared for the next stage when actually that knowledge can help you stay focused that next steps are necessary.
Wishing your hubs a speedy recovery.
Medicare pays up to 100 days. First 20 days is 100%, 21 to 100 is 50%. The balance is paid by the patient or if lucky the supplimental fully, partially or not at all. As said the 100 days is not a given. Its the period that Medicare will pay. After 100 days the patient pays fully. If ur husband is released before the 20 days is up, then you owe nothing. If he is release any time after that, your out of pocket is the 50% a day that he is in after the 20 days. So if he is in 30 days, you will owe 10 of those days, at $150 a day, thats $1500. (More since the daily cost has probably risen) If your suppliment picks up the 50% then you owe nothing. You don't have to stay in the whole 100 days to get full coverage.
When ur husband was admitted there was paperwork to be signed considering payment. It should have been explained to you how Medicare pays. Then what your cost will be if he is in passed the 20days. They should have told you then what your suppliment will cover. If there is any out of pocket it should be mentioned on the paperwork you signed. Its usually how much a day. If this was not done, you need to request a meeting with the financial clerk so you know where you stand financially.
The intake person needs to know how you are going to care for your husband when he is released. They are not allowed to discharge unsafely. Are you going to have everything he needs to be cared for him safely. A shower chair for bathing. Bars of some sort in the tub. A walker. Sometimes they send him home with "in home care" temporarily. He may get some PT/OT. They can also evaluate your home to see what might be needed for his care.
You can have your husband evaluated for 24/7 care while in rehab. If found he needs it and you find u can no longer care for him, then he can be transferred to a SNF. But, this will need to be privately paid. If no money but SS and a pension Medicaid can be applied for. This may be what the intake person is trying to find out. What you need to care for him. Are you hiring aides, do you already have aides?
Medicaid gets involved when there is a Community Spouse. But I am not going to touch on that because you may not even be considering Medicaid yet. When ur, come back.
My dads supplemental paid everything that Medicare paid on 1st. If Medicare approved it, they paid the balance. He never paid anything except prescription co-pays and the 182.50 deductible.
It is always worth a phone call to find out what they are paying if there is any question.