When my elderly mother suffered her first round of pneumonia due to aspiration, she ended up in the hospital where the doctors installed a peg tube. I was advised she had to go to a nursing home, when released. Since she was Medicare qualified she would go into Skilled Nursing. The case worker at the hospital and two staff people at the nursing home I selected all explained it as: Medicare will pay everything for “skilled nursing” for the first 20 days. Since my mother had a peg tube installed, she qualified for 100 days (certain conditions warranted longer time). I asked repeatedly “Medicare pays for everything up to 100 days because she has a peg tube?” and was told yes.
They were wrong. Medicare pays everything for 20 days. After that, under certain conditions, they pay for everything EXCEPT $133.50 per day. That amount goes up every year. Operating under the assumption Medicare paid 100%, I encouraged the therapist to continue working with her to improve her swallowing technique. It didn’t really help, but we tried. After 31 days, she was released from “skilled” into long term care. I was surprised by the invoice I received from the nursing home for those extra 11 days. That’s when I learned, everyone *meant* to say “Medicare pays for everything up to 100 days EXCEPT for $133.50 per day”. We paid the money and I’m glad she had the extra therapy, but it blew our budget out of the water. If your relative doesn’t have supplemental insurance (or the nursing home is out of network for some supplemental policies), you
will have to pay the extra amount.
I should’ve called Medicare and asked. I trusted the case worker and the nursing home staff. I had the government Medicare booklet, but due to stress and worry, it was difficult to wade thru the double-speak of government publications. There’s a toll free number (800-633-4227). If you’re dealing with medical expenses and Medicare, call them. You don’t want any surprises.