Insights
the blog of Porter Hills
Be in the know! Insurance and Skilled Nursing
Sarah Seeley
Financial Liaison
Porter Hills
Watch the 13 On Your Side Senior Wellness Segment on this topic.
There are two types of stays in a Health Center
- Short term for rehabilitation.Average length of stay for rehabilitation in a health center is 14 days. Most expenses are covered in your health plan benefit.
- Long term residential care for those who need constant supervision and unable to stay in the home.
Rehabilitation is paid for by health insurance and the benefits vary with the type of plan.
- Medicare A coverage
24-hour care in a hospital rehabilitation center. Medicare may pay for rehabilitation in a skilled nursing center when it is followed by a three-day inpatient hospitalization. Days 1-20: covered 100%, Days 21-100: copay of $170.50 (increases yearly) - Medicare A and a supplemental insurance coverage(BCBS, AARP, Aetna, Tricare United Health Care)
The supplemental insurance covers all or up to a portion of the Medicare copay for days 21-100 of $170.50. Leaving minimal to zero patient responsibility. - Medicare Advantage Plans coverage(Priority Health, Med Plus Blue, Blue Care Network, Etc)
These have their own set of requirements that are verified prior to admission. Staff at the rehabilitation center will verify all benefits prior to admission, based on the particular plan.
What services are included in the rehabilitation stay?
- 24 hour care provided by an Interdisciplinary Team of Registered nurses, PT, OT, SLP, Social work services.
- All meals
- Housekeeping
- Room and board
What should I do first?
- You’re in the hospital and it is decided you need rehabilitation prior to returning home.
- The hospital staff will coordinate your discharge to a rehabilitation center.
- It is up to you to decide the location
- The staff will then make the arrangements for you.
Moving into a Health Center long-term/permanently is NOT a paid benefit through insurance plans.
Most common ways to pay for 24 hour nursing care is privately (out of pocket) and through State funded programs (Medicaid) for those who qualify based on income.
BE IN THE KNOW!
Contact your insurance health plan and find out what your financial responsibility may be for Skilled nursing health center. Most health centers have an admission process that includes an application, financial disclosure and medical record review.
Finding the right fit for a rehabilitation or long term setting:
- Visit the community
- Talk to staff and residents
- Find a central location for family
- Discuss with peers any recommendations
- medicare.gov search “nursing home compare”
