STEP 1: 

Types of INSURANCE 

  • Medicare Stay- Generally, a Medicare A SNF (Skilled Nursing Facility) stay requires a 3-night minimum inpatient hospital stay.  The benefit offers up to 100 days of skilled nursing care with the first 20 days covered at 100% and 80% thereafter.  One must continue to require a skilled need the entire 100 days to remain under the benefit. Some examples of skilled services: IV medication (not fluids for dehydration), stage 3 wound or higher, physical therapy, occupational therapy, speech therapy,  brand new g-tube etc. 

  • Insurance- (May include medicare replacement plans. Medicare advantage,etc.)  When signing up for one of these plans be sure to review the skilled nursing benefit.  Sometimes these plans do not offer the same exact benefit for skilled nursing that the traditional Medicare A covers.  Insurance or managed care plans have different requirements and do not always require a 3-night staff in a hospital. The stay tends to be driven by the insurance company.  They usually require facility notes to be submitted at certain time frames and the insurance company determines stay qualification and continued to stay based on notes submitted.  The discharges tend to be abrupt and many often feel they were discharged without adequate notice from my experience.

  • Medicaid- To be eligible for Medicaid one must not own any assets of value and typically can only have a very small amount of cash available.  If one needs care at a skilled level and does not have money to pay privately family can assist to apply for medicaid. Any funds above the allowable amount must be spent down using qualified expenses (It can not be given to family) such care payments, burial plans, etc.