How Many Days Does Medicare Cover in a Rehab Facility?

What does Medicare Part A cover?

Medicare Part A, also known as hospital insurance, helps cover inpatient care in hospitals and skilled nursing facilities including rehabilitation facilities. To be eligible for Medicare coverage for skilled nursing care, the care must be medically necessary and not custodial care. Medicare does not cover custodial care, which is help with activities of daily living, such as dressing, eating, or bathing.

When Does Medicare Pay for a Skilled Nursing Facility?

An individual is usually qualified to receive SNF coverage through Medicare Part A if he or she has been:

1. admitted to the facility is within 30 days of the date of hospital discharge;
2. the prior hospitalization was for at least 3 consecutive days, excluding the day of discharge;
3. the resident requires daily skilled nursing or rehabilitation services that can only be provided in a SNF;
4. the resident is admitted to the facility to receive treatment for the same condition(s) for which he was treated in the hospital;
5. a medical professional certifies that the resident requires daily skilled nursing care.

Can you lose Medicare coverage for a skilled nursing facility?

Coverage for rehabilitation under Medicare Part A is intended to be short-term. As mentioned, the first 20 days in the rehab facility are covered in full by Medicare. After admittance to a facility, the patient is evaluated periodically. Coverage can be terminated before the 100 days is up if an individual will not participate in rehabilitation treatments, or it’s determined the treatment will not help the person preserve or improve their skill level.

If a patient does not qualify for Medicare but their family does not have the resources at home to care for them, Medicare will not provide payment for however long it takes to make a plan or apply for Medicaid. Once Medicare terminates coverage, the patient needs to return to his or her home or start privately paying for care which can cost hundreds of dollars a day.

Does Medicare 100 Days Reset?

A patient can qualify for a new 100-day benefit period only after being out of a hospital or skilled nursing facility for 60 days in a row. It is a myth that Medicare pays for long term care in a nursing home. The only government program that pays for long term care in a skilled nursing facility is the Chronic Medicaid program which has its own rules for eligibility. However, community Medicaid is an alternative to consider for those who need daily assistance but have run out of their Medicare days or cannot afford or qualify for Chronic Medicaid.

Navigating the various payment sources for rehabilitation and beyond can be complicated. Be sure to understand the coverage you have and seek the guidance of competent elder law professionals to advise on additional coverage.