Hospital coverage through Medicare

Hospital coverage through Medicare

Nursing Home or Rehabilitation; doesn’t Medicare pay for that?

 

So often questions about Medicare coverage for rehabilitation come up after the fact so let me address one of the most common questions here. When you or a loved one leaves the hospital you are likely relieved or thinking of the next steps of care; but so often patients and their families are bewildered and overwhelmed about the lack of insurance coverage for rehabilitation and/or skilled nursing care. If you are 65 or over you likely have Medicare coverage A and B. So here are some basic facts about Medicare coverage for rehabilitation or skilled nursing care:

Medicare coverage part A is “hospital insurance” covers skilled nursing or rehab care ONLY after:

You meet the 3 DAY impatient hospital stay. This means you must be FORMALLY ADMITTED to the hospital. IF you are in the emergency room for 3 days but not admitted to the hospital you will not receive insurance coverage for your rehabilitation or skilled nursing care.

Even if you feel you have great insurance to fill in the gaps of Medicare A and B coverage without that 3 day hospital admittance there is likely no insurance that will cover your rehabilitation or skilled nursing care.

What do you do? You need an advocate who can ascertain from your healthcare team if you will be admitted, help determine your choices and advocate for your hospital admittance. And plan ahead

Below are some original Medicare costs and link here for more info on Medicare Part A hospital and skilled nursing facility coverage. Remember that even when you receive Medicare part A coverage for hospital or skilled nursing care it may not fully cover for the length of stay needed.

Your costs in Original Medicare

You pay:

  • Days 1–20: $0 for each benefit period.
  • Days 21–100: $161 coinsurance per day of each benefit period.
  • Days 101 and beyond: all costs