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What You Need To Know About A Rehab Stay

So your doctor has told you that you need a rehab stay to build your strength back up or recuperate from a procedure.   Here are some things you need to know.  First, what is required for Medicare to cover your expenses, second what Medicare covers and third what your provider options are.

Medicare Details

Neither Medicare nor Medicare Supplement Plans pay for assisted living if that is the only type of care needed.  Assisted living is non-medical care such as assistance with bathing, dressing, eating, and toileting.  No matter whether the care is received in the home or in a long term care community, Medicare will not cover the costs.  To cover these expenses, people rely on personal savings and income, long term care insurance or a combination of both.

Medicare Part A will cover medically necessary skilled nursing care – for a limited time and limited amount – if certain requirements are met, including but not limited to:

  • The recipient must have had an “admitted” hospital stay of three midnights or longer. Admitted means the recipient cannot have been in a hospital for “observation” purposes.
  • Admittance into the skilled nursing facility must take place within 30 days of the hospital stay.
  • A physician must decide that daily medical nursing care or rehab is necessary.
  • Care must be provided in a Medicare-certified facility. (Medically necessary services provided at home by a Medicare-certified home healthcare agency may also qualify for Medicare coverage.)

Typically, Medicare’s coverage of skilled nursing care follows a serious medical occurrence, such as a stroke, heart attack or major surgery.

Don’t confuse Medicare with Medicaid.  Medicaid is a government safety net program that only applies for those who essentially no longer have the assets and income available to pay for necessary care.  Unlike Medicare, Medicaid will cover some of the costs of assisted living services for those who qualify.

What Medicare Pays

The full cost of skilled (medically necessary) nursing care – including the cost of a semi-private room, meals, therapies, medications, and more – will be covered by Medicare for the first 20 days (as long as you meet medical criteria all 20 days).  Between 21 and 100 days, if you are deemed to still be in need of such services, you may pay a daily co-insurance many times covered by supplemental insurance. (Whether or not you are deemed to still be in need of such services may be a point of debate in some cases.)  If care is required beyond 100 days, then Medicare ceases to provide coverage and the recipient of the services is required to pay 100 percent of the cost out of their pocket.  So, if it is determined that you can no longer live independently in a safe manner and you need skilled care beyond 100 days, you will be paying for it by means other than Medicare.  Another factor to be aware of is the impact of Managed Care insurance companies.  These companies offer what’s known as Medicare Advantage Plans and they issue prior-authorization (PA) giving permission to admit a patient with agreement to pay for services rendered. They also decide when the last covered day and discharge will be.  This is one of the major differences from Medicare coverage.

Who Can Provide Rehab Services

Sometimes when discharging from a hospital and in need of further rehabilitation services, acute care hospitals have swing bed units available to provide services.  Swing beds are units within acute care hospitals where patients receive the same skilled level of care that is available at skilled nursing facilities.  Skilled nursing accommodations are those places that provide round the clock help while providing rehabilitation services in speech, occupational and physical therapy to help people rehabilitate back to their highest level of functioning.  The same Medicare coverage applies to both swing beds and skilled nursing facilities.  Patients can choose which option works best for their circumstances.

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