Knowing how long anticipated stay for rehabilitation will help you determine cost of care and resources needed to pay for stay. The professional staff of hospital will be able to give you an estimated time frame. When resident is assessed at nursing home they will give you another time frame based upon resident’s health condition, resident’s ability to tolerate rehabilitation activity and level of independence required for where resident will reside after their rehabilitation stay.

Nursing home skilled units want to be assured that necessary steps will be taken to assure that they will be paid. Nursing homes are most familiar with Original Medicare, Medicare Advantage Plans, Medicare Managed Care Plans, Medicare Preferred Provider Organization Plans, Medicare Private Fee-for-Service Plans, Medicare Specialty Plans, federal employee health program, military health program and railroad retirement programs. If your patient has one of these, they will be highly considered once that payer source is verified.

Medicare Part A is primary source of insurance that will pay for a skilled nursing home stay. Medicare pays 100% of day 1 through day 20 and from day 21 up to day 100 Medicare will pay everything less $114.00 per day co-pay as long as resident is making progress towards their rehabilitation goals.

If, Medicare is managed through a HMO (Health Management Organization) it usually pays 100% of rehabilitation stay. The HMO determines length of stay by assessments provided to them by nursing home rehabilitation staff and level of independence required where resident will reside after their rehabilitation stay. The HMO utilizes a Nurse Case Manager and a Medical Director who is a physician to make this determination.

Secondary insurances with Medicare Supplemental Coverage will usually pay $114.00 per day co-pay from day 21 through day 30 up to day 100 depending upon tier level of insurance plan and some tiers will some times pay up to 120 days. It is important for you to know what your insurance will cover.