Medicare Frequently Asked Questions

Q: What does Medicare pay for in a skilled nursing/rehab facility?

A: Medicare covers 100% of the cost of a skilled nursing/rehab facility for the first 20 days. The only exception is what may be incurred that is a Non-Medicare covered service, such as transportation to and from doctor’s appointments or procedures and phone or cable service (which may or may not be a free service of the facility). On day 21 you are responsible for a co-pay in the amount of $124 per day thru your skilled stay up to a maximum of 100 days. This co-pay may be covered by a secondary insurance or Medicaid if you are eligible.

Q: When would I be eligible for a skilled nursing/rehab stay?

A: If you have had a 3 midnight qualifying hospital day in an acute care hospital for which you continue to require skilled services after being discharged from the hospital. The skilled service would be skilled therapy that you can not receive on an out patient basis due to transportation or other care needs, or skilled nursing such as IV therapy, wound care, skilled nursing assessment and education.

Q: Will Medicare cover me the full 100 days?

A: Only if you continue to make progress towards your Medicare goal thru participation in skilled therapy and you continue to require a daily skilled service.

Q: What is a Medicare goal?

A: After discussion and assessment, your Medicare goal is established by you with your skilled therapist or you and your licensed nurse. Your goal is usually based on your prior ability level - and the key is to get you back to your highest level of functioning and or stabilized condition that no longer requires skilled care from either a licensed nurse or therapist.

Q: What do I do after Medicare will no longer cover my stay?

A: The discharge planner and the nursing team at the skilled nursing/rehab facility will work with you to schedule follow up care to assure a smooth transition back home or to a facility of your choice.  Staff is also available to make home visits prior to discharge to suggest environmental modifications or special equipment.

A Cadia Healthcare professional will be happy to review this information and answer any other questions you may have regarding Medicare, nursing and rehabilitation programs in Delaware and more.  Call Cadia Healthcare today at 302.427.8181