There is so much to understand when your elderly love once is hospitalized. First you have to be able to “speak the language” of the medical people to understand what is going on.
If you are lucky enough to figure that out, then you need to understand the insurance issues and the next steps after the hospital stay. Can they come home? Do they need care? Can they go to rehab? Who will pay for it all?
The Hospital social workers or case managers are there to help you through these questions. Often they do not have the time to help you fully understand your coverage or your options
Getting educated about these things is essential.
Medicare has a $1288 deductible for a hospital admission – if you have a traditional supplemental plan, this is likely covered. If you have Medicare Advantage plan this may be covered but there is still some type of deducible for most plans.
If you plan to go to sub-acute rehab (usually offered in a nursing home) Medicare requires that you have at least a 3 day admission in a hospital before they will pay for the sub-acute rehab stay. That means if you are in the ER for a couple of days or are in the “Observation unit” for any amount of time, and not admitted, you WILL NOT qualify for Medicare covered rehabilitation. Non-covered rehab can cost upwards of $450/day.
If you do meet the hospital admission requirements, then you can go to a sub-acute rehab under Medicare. Traditional Medicare will pay 100% of the cost for the first 20 days. From Day 21 through day 100 there is 157.50/day co-pay. Some Supplemental policies cover this. Some Medicare Advantage plans provide better coverage with lower or no co-pays. Ideally you should call your plan immediately so you are aware of the potential costs of a sub-acute rehab stay.
If you are going directly home, you will likely be referred to one of the many Certified Home Health Agencies (CHHA) in your area commonly referred to as the “Visiting Nurse.” Your Medicare coverage will cover these services. But don’t rely solely on them if you have a lot of care needs. They start with a Nurse or Physical Therapy visit within 24-48hrs after your hospital discharge. It can take days, a week or more an aide placement occurs. You may only get an aide 2-3x/week for 1-3 hours. You may need to consider arranging for private hire temporarily.
Reaching out to an Elder Care Consultant or Geriatric Care Manager to help navigate these murky waters can be very helpful.
Colin Sandler is a Licensed Clinical Social Worker and Certified Care Manager providing advice for aging to seniors and their families for over 20 years. Colin Sandler, LCSW, CCM, 2127 Crompond Road, Cortlandt Manor, NY 10567, [email protected], 914-924-2566