Even if Medicare determines that the patient no longer qualifies for coverage, the patient still has the right to bed in the rehabilitation center. In the Medicare world, each diagnostic group comes with its own set of guidelines for how many days of rehabilitation an average person will need to move to the next level of care. Medicare will pay for rehabilitation only for that period of time. After that, you will be discharged from the rehabilitation center and sent the house.
Don't be surprised to assume that your loved one will receive the full 100 days of Medicare. Make sure you have a plan to preserve assets while ensuring government benefits to help pay for long-term health care needs. See our article in the Long Island press. Nursing homes may attempt to unintentionally discharge a resident who is left without Medicare coverage or evict a resident who has Medicaid to free up a bed for a higher-paying resident. Nursing homes receive higher salaries from private residents (as well as those with Medicare).
Nursing home residents who are not ready to be discharged when Medicare coverage ends often apply for Medicaid for nursing homes. Medicare has two days after the due date for your loved one to finish medical care to decide if they will continue to pay for their stay in a nursing home. While the reasons for discharging and being unintentionally transferred to a nursing home vary, it's possible that it's because residents require a higher level of care than the nursing home believes it can handle or, more commonly, at the end of Medicare coverage. The nursing home resident does not pay for nursing home care after “reasonable and appropriate notice” and has not applied for Medicare or Medicaid.
As is usual in most of these cases, Medicare covered both the hospitalization and your rehabilitation stay in a nursing home (Medicare covers up to 100 days) for you to recover. Medicare will only pay for short-term stays of 100 days or less, for example, for rehabilitation after injury or illness. Medicare, federal health insurance for people over 65, will cover short-term skilled nursing care (up to 100 days) in Medicare-approved (certified) nursing homes. For older people who have Medicare Supplemental Insurance (MediGAP), their insurance generally covers this cost.
When Medicare stops covering your loved one's stay in a nursing home or skilled nursing facility, you have three options to take the next step. This motivation is not entirely unjustified, since nursing homes are subject to Medicare audits; and if Medicare determines that the nursing home has been treating patients for longer than necessary, the nursing home becomes responsible for reimbursing the costs to Medicare. If they were discharged from the nursing home with occupational or physical therapy orders, Medicare will cover the cost of these medically necessary services. The problem came when the nursing home told my father that his Medicare coverage had ended (well before the 100 days allowed) and that he was going home.
People who have run out of Medicare coverage or who can no longer privately pay for care in a nursing home must apply for Medicaid. For your loved one to maintain their quality of life and find the right support, it's essential to plan ahead how they'll pay for the care they need once they've received a notification of lack of Medicare coverage (NOMNC). In a case like that, Medicare won't continue to pay for a nursing home stay if the person doesn't improve.
