Is there a Medicare penalty for leaving a rehab facility too soon?

Published 12:01 am Saturday, May 7, 2022

Dear Toni,

         Ten days ago, I placed my mother who has Medicare in a “rehab facility” for approximately three weeks, thinking that her post-hospital therapy would go better there than it would here at home…. WRONG…. I enrolled my poor mother into The Halls of H*ll, and now, I desperately need to spring her OUT OF THERE!

         My problem is this: we are fearful that she will be penalized in some way for NOT staying the entire 20 days.

         Thank you in advance for the advice/help. Sincerely yours, Loretta from Denver

 

Hello Loretta:

I have never seen a Medicare penalty for not spending the 20 days in a skilled nursing or rehab facility. If you feel the facility is not giving your mother the care she needs, it is her right to leave. I would report her unhappiness to the facility’s administrator.

Before trying to release her from the rehab facility, I would talk with your mother’s doctor or facility’s case manager. A better alternative than bringing her home, is hiring a personal care provider to spend time with your mother and make sure that your mother is taken care of at the rehab facility. This will take some of the burden from you since you cannot be at the rehab center 24/7.

Medicare will pay only for medically necessary health related claims. Many believe that Medicare helps with Long Term Care, but Medicare will only pay for a skilled nursing/rehab facility stay. If one cannot qualify or does not meet Medicare’s qualification for skilled nursing/rehab facility care, then they may have to pay 100% of the cost.

Skilled nursing/rehab facility has 100 days of benefit with day’s 1-20 having $0 co pay per day and days 21-100 with a daily co pay that changes each year. Medicare pays absolutely nothing for assisted living, personal care homes or extra provider care that is not medically necessary at home.

If your mother has a Long-Term Care policy, then it can help pay for non-medical service. If not, then she will have to pay for it herself until she spends down to qualify for Medicaid

There is financial help, known as the Aid and Attendant benefit from the VA for America’s Veterans and their spouses.

Here are tips to help you choose a non-medical provider:

  • Decide if “At Home Care” is the right choice. Non-medical or At Home Care is different than home healthcare provided with Medicare.
  • Evaluate the pros and cons of “at home non-medical caregivers,” assisted living, personal care, or nursing homes.
  • Determine the cost of Long-Term Care options.

New At-Home Care Short-Term plans with very few medical underwriting questions are available nationwide. When one cannot qualify for Long-Term Care underwriting, this Short-Term Care plan is a new option.

 

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