Medicare part A benefits-
1) Require a 3-day inpatient stay at the hospital (you must be admitted and not remain in observation)
2) Require a skilled service such as Therapies (Physical, Occupational, Speech), Intravenous antibiotics, wound care requiring specific treatments which can-not be managed in a home environment.
3) Your Medicare benefit states you are eligible for up to 100 days of skilled nursing. To continue to use your benefit you must be aware that you must continue needing a skilled service, and you must be making progress.
4) The skilled nursing inter-disciplinary team will continue to review your insurance coverage, and your progress and aide in determining if you continue to be eligible to remain in a skilled service.
5) Medicare payment 1-20 days of skilled nursing covers 100%. Days 21-100, Medicare pays 80% and 20% is payed for by you or your secondary insurance if you have Medi-Cal, partnership, or Private insurance.
You can download a free guide from the Center for Medicare and Medicaid Services. https://www.medicare.gov/Pubs/pdf/10153.pdf
Private insurance benefits
1) Each insurance is different, and it will depend on which plan you have, if you are able to have an inpatient rehab stay and how long they will cover this expense.
2) Private insurances require a pre-authorization prior to admission to a skilled nursing facility under inpatient services.
Partnership Healthcare (Medi-Cal)
1) Under this plan you are eligible for skilled services, however, like private insurance, they will require a pre-authorization prior to admit
2) You may be required to pay a share of cost with your skilled nursing benefit, and what that share of cost would be.