by Sara Meyers, Esq. and Reilly Graupp, MSW
A loved one being admitted to a rehabilitation facility can mark a transition for many families. Navigating the rehabilitation facility process and transitioning to meet care needs can be daunting. Families are often told how many days of care their insurance has approved from the beginning only to be told discharge is being planned for sooner than expected. Understanding what approved days mean, what can happen when coverage ends, and what options may be available is essential to preventing a crisis. Having this information allows families to make informed decisions, plan ahead, arrange appropriate care, and prepare for any potential financial costs.
Understanding how Medicare and Medicaid benefits apply to your specific situation can make a significant difference in how you plan for what comes next. At Futterman Lanza, LLP, we work with families throughout Nassau and Suffolk Counties navigating this uncertainty.
Why Your Time at the Facility May Be Shorter than Expected
The number of days Medicare will cover for rehabilitation facility care depends on several factors. Medicare coverage can extend to a maximum of 100 days for one length of stay; however, reaching 100 days is not guaranteed. In fact, many patients are discharged before using all of their approved days.
Medicare has limitations to full coverage of rehabilitation facility stays. Under Original Medicare (part A and B), Medicare covers the full cost of the rehabilitation stay for the first 20 days. Beginning on day 21 through day 100, the patient is generally responsible for a daily copay. A Medicare Supplement Insurance plan may cover some or all this copay.
Another important factor is medical necessity. Medicare coverage for a rehabilitation facility stay depends on the patient continuing to require covered skilled services. These may include physical, occupational, speech therapy, or skilled nursing care. If a patient’s condition improves to the point that skilled care is no longer medically necessary, the facility may discharge the patient even if there are Medicare-covered days remaining.
Private insurance generally operates under similar principles. An insurer may initially authorize a certain number of rehabilitation days based on the review of the patient’s medical records. They may conduct additional reviews throughout the stay and if the patient’s progress plateaus or the insurer determines that continued skilled services are no longer medically necessary, coverage may end before the original authorized number of days have been used.
Understanding the difference between approved days and days that are actually covered can be critical when planning for a loved one’s care. The professionals at Futterman Lanza, LLP can help families understand their options and determine what steps may be appropriate for their specific circumstances.
What Happens When You Leave the Facility Before You Are Fully Ready?
After Medicare coverage ends, many families try to continue providing the care their loved one needs by privately paying for a long-term nursing home stay, assisted living placement, or personal care aides at home. These costs quickly become very expensive. This often results in families seeking other options, including applying for Medicaid which can cover caregiving needs either in a nursing home facility or in the community.
Futterman Lanza, LLP walks families through this process. Our attorneys and paralegal team assist families in meeting Medicaid eligibilities, applying Medicaid, and preserving assets. The Futterman Lanza, LLP team has decades of experience with Medicaid, understanding how to move applications as quickly as possible to meet family needs.
Why Starting to Plan on Day One Matters
Many families are unprepared for how quickly a loved one’s care needs can change or how complex long-term care can become. While the goal is often to help a loved one remain as independent as possible, waiting to plan for future long-term care can leave families making important decisions under pressure and uncertainty.
Medicaid planning and the application process can be complex and time-consuming. Starting conversations early about potential care options and benefits can help families develop a plan before a loved one enters a rehabilitation facility or requires additional care at home. Discussing long-term care from the beginning of a rehabilitation facility stay, or even before admission, can help create a smoother, more coordinated transition if the next level of care is needed.
Our team assists families in understanding the benefits and resources available, along with determining when it may be appropriate to begin the Medicaid application process.
How Futterman Lanza Can Help Families in Nassau and Suffolk Counties
We work with families throughout Long Island, helping them understand their options before, during, and after a rehabilitation discharge. Our team at Futterman Lanza, LLP provides guidance on long-term care planning, Medicaid eligibility and applications, available benefits, while also connecting families with trusted community resources and other professionals with additional support is needed. Our goal is to help families make informed decisions, plan ahead, and navigate the transition to the next level of care with greater confidence.
