If you’re seeking inpatient rehab or long-term care, you are likely exploring a skilled nursing facility or a Center for Rehabilitation and Nursing Care. Fortunately, several insurance options are available. Below is useful information about the types of coverage available:

Medicare:

Medicare Part A (Hospital Insurance) typically covers stay at a Center for Rehabilitation and Nursing Care or a skilled nursing facility (SNF) for rehabilitation and recovery for a limited period, under the following specific conditions:

• Qualifying Hospital Stay: You must have a prior inpatient hospital stay of at least three consecutive days.
• Timely Admission: Admission to a Medicare-certified SNF must occur within a short time (generally 30 days) after hospital discharge.
• Medical Necessity: A doctor must certify that you require daily skilled care, such as intravenous fluids, medications, or physical therapy, which must be provided by or under the supervision of skilled nursing or therapy staff.

For more coverage information, check your plan’s Summary of Benefits. The latest information can also be obtained directly from the Medicare website. 

Medicaid:

Another option for paying for these services is if you have Medicaid. Nursing Facility Services are provided by Medicaid-certified nursing homes, which primarily provide three types of services:

• Skilled nursing or medical care and related services.
• Rehabilitation needed due to injury, disability, or illness.
• Long-term care —health-related care and services (above the level of room and board) not available in the community, needed regularly due to a mental or physical condition.

Generally, to qualify for Medicaid-funded skilled nursing care, applicants must demonstrate financial need and a medical necessity for such services. Financial eligibility typically involves meeting income and asset limits.  Medical necessity is determined by assessing the individual’s need for a nursing facility’s level of care.

It’s important to note that Medicaid programs are state-administered, leading to variations in coverage and eligibility requirements across different states. Therefore, you should consult your state’s Medicaid office or an elder law attorney to understand specific criteria and benefits in your area.

For more information on Medicaid coverage related to services provided by a skilled nursing facility, check your local Medicaid website. 

Medicare Advantage Plan:

Medicare Advantage (MA) plans may include inpatient rehabilitation and long-term care, depending on the specific plan and services needed. Coverage typically includes physical, occupational, and speech therapy, skilled nursing care, medications, and medical supplies. However, many plans require prior authorization, and coverage is often limited to a specific number of days. Costs such as co-pays and deductibles vary by plan, making it essential to review the details of each option before enrolling.

Private Insurance:

Private insurance policies may cover skilled inpatient care, but coverage levels depend on your plan. Check with your insurer for details.

Private Pay :

Skilled inpatient care can also be paid for privately if a patient or resident does not meet Medicare or Medicaid eligibility criteria or does not have coverage under an insurance plan. 

For more information, check out these related articles:

• A Guide to Skilled Nursing Care: Get a high-level overview of what it is and when it may be right for you or a loved one. 
• Getting Started with Skilled Nursing Care: A guide to understanding the steps involved in choosing a skilled nursing center and preparing for the transition.

This information is for educational and directional purposes and is not intended as financial advice. To confirm your coverage details, refer to your plan Summary of Benefits or visit the official Medicare and Medicaid websites.

MJHS is Here to Help

MJHS offers two exceptional Centers for Rehabilitation and Nursing Care centers to support your needs: MJHS Isabella Center in the Washington Heights section of Upper Manhattan and MJHS Menorah Center in Manhattan Beach, Brooklyn. Both are dedicated to providing compassionate, high-quality, expert care tailored to your unique needs in conveniently located and beautiful surroundings. Contact us today to learn more about our services and how we can support you or your loved one.