Many have heard of Medicare’s 100 Day Rule – but what exactly does that mean?
To put it in the most simple terms, it means Medicare will pay for short-term stays in a skilled nursing rehabilitation facility that is certified by and participates in Medicare, when certain conditions are met.
The conditions that must be met in order to qualify for this coverage include:
- The individual must have Medicare Part A
- The individual must have had at least a 3-night stay in a hospital (as an admission, NOT for observation only)
- The individual must need medical/nursing services or therapy as determined by a doctor
Medicare will pay all medical costs related to the skilled services for days 1-20 and all but $161 of days 21-100. Depending on the individual’s coverage, some supplemental policies will pick up the co-pay for days 21-30 or even 21-100.
A common misconception is that everyone is guaranteed 20 or even 100 days of coverage. Unfortunately, that is incorrect. The individual must continue to need and show benefit from the services they are receiving, and improvement in their condition. If the patient refuses to participate or their progress plateaus while in therapy, Medicare will deny further coverage. The nursing home or rehabilitation facility is required to provide 48 hours advance notice before coverage is discontinued. Although generally, this is not a surprise since the patient and their family have been involved in care plans and progress updates and should already have an expected discharge date.