Medicare Myths vs Facts

By Sharon Sharland, Director of Admissions, Jeffrey & Susan Brudnick Center for Living
With the ever-changing field of short-term rehab and long-term care, it can be hard to understand the requirements. There are many preconceived notions people have about Medicare and other billable insurances that may or may not be applicable to a short-term rehab stay and/or long-term care. Here are some of the most common myths we encounter:
Myth #1: If I have Medicare, I will get 100 days of short-term rehab.
Medicare has a 100 day per spell of illness benefit. This means you do not automatically stay 100 days for rehab. Your length of stay in a short-term rehab facility is determined by your progress toward your rehab goals, and is often as few as 7 days.
Myth #2: I can call a skilled nursing facility and request that my admission be paid for under my Medicare benefit.
To be eligible for admission to a skilled nursing facility for short-term rehab under your Medicare benefit, you must have a 3 night stay in an acute hospital and have a need for in-patient short-term rehab services. It is not automatic that you go to an in-patient short-term rehab facility after a hospital stay. Your hospital case manager will guide you on this.
Myth #3: My mother needs to stay for long-term care after short-term rehab. She will use 100 Medicare days and then have a different payer.
Medicare payment ends when you have reached your rehab goals. A payer source for long-term care is necessary because Medicare does not pay for long-term care.
Myth #4: All skilled nursing facilities are the same.
All skilled nursing facilities are not the same. From operations to accepted insurances, there are many differences among the skilled nursing facilities in Massachusetts. A tremendous resource for clarification and information is www.medicare.gov.