In such situations, the individual who is anticipating a rehab stay has the benefit of planning ahead including visiting facilities and having questions and concerns addressed. However, because of ever changing health insurance rules, along uncertainty of life’s hazards such as icy driveways, many can benefit from proactively becoming more knowledgeable about this type of care.
Generally speaking, an individual may be referred to a skilled rehab when determined by their physician that, while often only temporarily, “daily care under the direct supervision of skilled nursing or therapy staff is required (Medicare.gov).” For those with traditional Medicare, obtaining the “ticket” for admission and coverage will also include the need for a three-night inpatient (not observation) stay in the hospital. It is important to note that even a stay for multiple nights in the hospital may be classified as an observation, rather than in patient stay. Observation stays DO NOT count toward the three-night requirement. Should there be doubt regarding hospital status, it is strongly recommended that you ask for clarification from the case manager.
Currently, traditional Medicare “A” pays for the first 20 days of care in a skilled rehab. Co-pays begin on day 21 through day 100. Medicare “A” payments cease when skilled therapy goals have been met or the rehab stay exceeds 101 days. Those with coverage through a Medicare Advantage Plan or other insurance may or may not have the three-night admission requirement, other differing admission criteria along with the likelihood of varied co-pay expectations.
Because hospital stays can be stressful and often fraught with feelings of limited control, many armed with this knowledge many rehabs do what they can to help create a more person-directed environment. Therefore, it is encouraged that when meeting with admissions staff, time be spent articulating personal preferences. For example, it is of little benefit to provide early morning therapy to someone who routinely sleeps late. Gayle Cohn, a social worker at a skilled rehab in Kettering, shared that she and her team adhere to a philosophy that open communication, ongoing dialogues and requested adaptations are crucial for a successful stay in the skilled rehab.
For those individuals who are anticipating a rehab stay or unexpectedly find themselves in need of a skilled rehab stay it is strongly encouraged that you do homework prior to admission. This should include finalizing specifics regarding benefits and possible out of pocket costs. You should also contact the rehab of choice directly to best determine insurance coverage, personal “fit” and if they anticipate availability. To quote playwright George Bernard Shaw “the single biggest problem in communication is the illusion that it has taken place.”
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