Toni says: Is there a medicare penalty for leaving rehab too early!!

By Tony King

Dear Tony,

Ten days ago I placed my medicare mother in a “rehabilitation facility” for about three weeks, thinking her post-hospital therapy would go better there than she did. would be here at home…. WRONG…. I enrolled my poor mother in The Halls of H*ll, and now I desperately need to get her out of there!

My issue is this: we are concerned that she is being penalized in some way for not staying the entire 20 days.

Thanks in advance for any advice/help. Sincerely, Loretta from Sugarland

Hello Loretta:

I have never seen a penalty from Medicare for not spending the 20 days in a qualified nursing or rehabilitation facility. If you think the facility isn’t giving your mother the care she needs, it’s her right to leave. I would report his dissatisfaction to the administrator of the establishment.

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

Medicare will only pay medically necessary health-related claims. Many believe Medicare helps with long-term care, but Medicare will only pay for a stay in a qualified nursing or rehabilitation facility. If a person cannot qualify or does not meet Medicare’s qualification for skilled nursing/rehab, they may have to pay 100% of the cost.

A qualified nursing/rehabilitation facility has 100 days of benefits, with days 1-20 having a $0 per day copayment and days 21-100 with a daily copayment that changes each year. Medicare pays absolutely nothing for assisted living facilities, personal care homes, or extra care from a provider that is not medically necessary in the home.

Confused and stressed Americans need help at home with daily routines, involving functional mobility and personal care, such as bathing, dressing, grooming and preparing meals.

If your mother has a long-term care policy, she can help pay for non-medical services. If not, she will have to pay herself until she spends to qualify for Medicaid

There is financial assistance, known as the VA’s Aid and Attendant Benefit for US veterans and their spouses. This program is a secret that many do not know. There is over $20 billion available to veterans in the form of a pension, so a veteran or a veteran’s spouse who needs extra care at home or to help pay for assisted living or non-medical personal care at home.

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

• Decide if “home care” is the right choice. Non-medical or home care is different from home care provided with Medicare.

• Evaluate the advantages and disadvantages of “non-medical home care providers”, assisted living facilities, personal care or nursing homes.

• Determine the cost of long-term care options.

Recently, a new “short-term” home care plan with very few medical underwriting questions was released in Texas. When one cannot qualify for long term care underwriting, this short term care plan is a new option. Sign up for the Toni Says® Medicare newsletter to keep up to date with Medicare rules and changes at www.tonisays.com.

• The Confus about Medicare Zoom webinar will take place on Thursday, May 19 at 4:00 p.m. Central Time Visit www.tonisays.com to register for the Toni Says online webinar.

Toni King, author of the new Medicare Survival Guide® is for sale at www.tonisays.com Email your questions or to schedule a “Medicare Confusion Workshop” for your professional organization or your church at [email protected]

About John Tuttle

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