Medicare coverage/allowances can be difficult to understand and navigate with their ever changing costs, options, and plans. Here are some helpful tips to help you understand Medicare coverage:
- For Medicare to pay for skilled nursing care and rehab, you need to have a 3 night hospital stay prior to admittance to skilled care/rehab.
- Medicare pays 100% for the first 20 days in skilled care/rehab, then starting on day 21 Medicare pays 80%. The 20% co-pay that is left is a rate set by Medicare and it changes yearly.
- For 2019, this co-pay is $170.50. If your Medicare supplemental policy has a skilled care/rehab benefit – this will vary between plans of how much of the co-pay they will pick up.
A couple of helpful reminders:
- There is a misconception that Medicare automatically pays for 100 days in a skilled nursing facility. While this is true, you must have a skilled need such as therapy, IV medications, significant daily wound care or a new feeding tube. Your skilled stay may be based on progress in therapy, and if you reach a plateau or your maximum rehab potential, Medicare will no longer pay for skilled nursing care.
- Medicare advantage plans- choose wisely! Not all plans pay for skilled nursing care like Traditional Medicare does. When shopping for a plan, ask for details of what is covered, any co-pays and authorization process. Usually these plans request clinical information to review before authorizing your skilled rehab stay. This authorization process can delay your admission to the rehabilitation area for 24-72 hours.