Medicare rules about rehab coverage can be tricky. Pay attention to the following myths:
1. After a hospitalization, rehab coverage under Medicare A is pretty much guaranteed.
Not always. Rehab in a skilled nursing facility requires three overnights in the hospital. In addition, the person must need skilled services, such as Physical Therapy, Occuptional Therapy or extensive nursing care. An attending physician must write orders for these services and must justify them according to the rules of Medicare.
2. People can stay 100 days in a rehab center under Medicare A.
It’s rare for someone to actually qualify to stay the full 100 days. The length of stay is determined by the person’s diagnosis and his or her progress. Rehab staff chart the progress and report weekly. When a person “plateaus,’ or stops improving, the rehab staff gives written notice, informing the person of the last covered day under Medicare A.
3. Medicare A services in a rehab center are covered in full by the Medicare program.
Medicare A covers the first 20 days: room and board, therapies and most supplies. At Day 21, there is a copay of $134 or higher, depending on a person’s income. Copays are often paid by a person’s health insurance.
4. After a person leaves a rehab center, he or she can no longer receive therapies.
Therapies can continue, providing the physician writes the orders that these will benefit the patient and comply with Medicare guidelines. These therapies are performed less often, and can be done in an out-patient center or in a person’s home. They’re covered under Medicare B. There is a copay.
5. Medicare gives you a lot of choices for rehab centers after hospitalization.
If you or a loved one have traditional Medicare coverage, you can choose virtually any nursing home in your area for rehab. If you have a managed care insurance, such as a Medicare Complete Plan or Tricare for military families, you may be restricted in your choices of rehab centers.