Medicare is a government-sponsored health insurance program in the US that covers healthcare for people over the age of sixty-five, as well as some persons will disabilities and terminal illnesses. It’s a social service that helps ensure people receive quality healthcare as they age. As with any health insurance program, there are limits and rules as to how it works. Let’s see how it plays out practically.
Medicare parts A and B
There are four parts of Medicare that cover different services. Medicare part A covers mostly inpatient treatment, and Medicare part B covers mostly outpatient services. (Part D covers medication and part C allows patients to choose an alternative plan.) A patient in rehab may be eligible for coverage through Medicare under parts A and B for different services. For example, someone may begin rehab as an inpatient and receive coverage through Medicare part A. He might be well enough to return home after thirty days, but still need to return daily to the facility for therapy as an outpatient; these services would be covered by Medicare as part B.
To qualify for coverage as an inpatient in rehab, someone must be enrolled as a patient in a hospital and then have continuing rehab services either in the hospital itself or in a separate rehab facility. Each patient has to meet a deductible before insurance coverage kicks in, and that fee right now is $1,365 per benefit period. The benefit period is defined as starting when the patient is first admitted for care, and it ends when the patient hasn’t received care for sixty consecutive days. From the beginning of the benefit period, Medicare will cover costs of the rehab completely for the first sixty days. After that, if the patient is still in rehab, he will need to sponsor a copayment of $341 each day until day ninety. Starting from day ninety-one, if he’s still in the rehab facility, he will need to sponsor a copayment of $682 from lifetime reserve days, of which there are sixty total. However, after the patient is home for sixty days, the benefit period starts again with the same original coverage.
Skilled nursing facilities
The coverage is different if the patient is residing at a skilled nursing facility. If that’s where the patient is, Medicare part A will cover the first twenty days of the stay after meeting the deductible. From day twenty-one to day one hundred, a daily copay of $170.50 is required. From day one hundred and one on, there is no Medicare coverage.
Medicare part B covers services on an outpatient basis, whether at home or in an outpatient facility. These could be many types of rehab services, such as physical or occupational therapy. After meeting the deductible of $185 annually, Medicare will typically cover the rest. There’s no time limit on how long Medicare will cover outpatient services, so long as the patient’s primary care provider determines that they’re necessary for the patient’s health.
At Sinai Post Acute Care Rehab Center we offer premium rehab services. Find out how we can offer you top-rated care and let’s see what’s covered through Medicare.