Will a second stay in a rehabilitation facility also be covered by Medicare?

1 answer | Last updated: Nov 16, 2016
Rmcgrattan asked...

My mother had a qualifying hospital stay in early August for brain trauma from a fall and was discharged to skill nursing. She spent 49 days there and then moved to an assisted living facility. She was hospitalized 3 weeks later for injuries from a fall. She went back to the assisted living facility and 4 weeks later spent 7 days in the hospital for brain trauma. She was released to rehab. Will any of this second stay in a nursing home be covered by Medicare?


Expert Answers

How long Medicare Part A covers your mother's inpatient care in a rehabilitation or skilled nursing facility, and how much it pays, depends on what's called a "benefit period." A benefit period is a single, continuous time-frame that begins the first day your mother stayed overnight in the hospital and continues until she's been out of the hospital for 60 consecutive days. Once she's been out of the hospital for 60 consecutive days, another benefit period would begin if and when she again became a hospital inpatient.

For your mother's stay in a rehabilitation or skilled nursing facility, Part A covers up to 100 days during any one benefit period. For the first 20 of those days, Part A pays the full cost; for the next 80 days, your mother is responsible for a co-payment of $133.50 per day.

In the situation you've described, it seems that your mother's first benefit period (following the fall and brain injury) ended while she was in the assisted living facility before her second fall and hospitalization. That's based on your report that she spent 49 days in skilled nursing and did not go back into the hospital until her second fall three weeks later (49 days plus 21 days (3 weeks) = 70 days). Since she was out of the hospital for more than 60 consecutive days, a new benefit period began the second time she was hospitalized.

 

Her second and third hospitalizations seem to be part of the same, new benefit period because there were only four weeks (less than 60 days) between them. So, following these second and third hospitalizations, she would have an additional total of 100 days of rehabilitation or skilled nursing facility coverage, with Medicare Part A paying the full cost of the first 20 days and your mother having a copayment for any days after that up to the limit of 100.