Medicare: Is 20 Days All I Get?

Dear Katie:

My husband will be facing a fairly complex surgery later this month. His surgeon wants us to tour skilled nursing and rehab centers in central Ohio before the surgery.

We are a bit confused about his Medicare benefit. A relative told us Medicare only pays for 20 days in a rehab center, but my husband’s doctor told us he will likely need to stay for several months.

Will we have to pay the entire expense for all of the days he is there beyond day 20? I’m just not sure we can afford that!

Grace

Understanding the Medicare Skilled Nursing and Rehab Benefit

Dear Grace:

The Medicare Part A Skilled Nursing and Rehab benefit can definitely be confusing! We hear questions similar to yours every day.

To help put your mind at ease, here is a quick overview of what you need to know.

If your husband spends three nights in the hospital at an inpatient level of care and his physician orders a transfer to a skilled nursing and rehab center:

  • Days 1 through 20 will be covered by Medicare at 100% of the cost.

  • After day 20 and through day 100, if your husband still qualifies for care, you will be responsible for a $164.50 (as of 2017) copay for each day your husband is in rehab. Medicare will pay for the remainder of the daily costs.

  • After day 100, you will be responsible for the full amount of his rehabilitation stay.

One thing to note is that if you have secondary insurance, such as a medigap policy, long-term care insurance, Medicaid, or employer/union insurance, it may cover the cost of the copay. The skilled nursing and rehab center you choose can help you make that determination.

It is also good to know that if your husband goes home before his Medicare benefit days (the 100 days allotted for rehabilitation in a skilled nursing and rehab center) have been exhausted, he can still return to the rehab center if things don’t go as planned.

If he meets the criteria for rehab and it has been 30 days or less since he was discharged, your husband can be readmitted to continue his therapy. This might give you peace of mind when it comes time for him to be discharged.

We invite you to call us or stop in if you have any more questions about this benefit. One of our team members will be happy to help!

Kind Regards,

Katie Jordan, LSW

Social Services

New Albany Rehabilitation Center, Skilled Nursing & Assisted Living