If you have a serious illness or injury, you may need inpatient hospital treatment. Afterwards, you might have recovered enough for your doctor to discharge you from the hospital, but still require rehab or other kinds of post-acute care to fully treat your health issue. Depending upon your condition, your doctor may advise you to seek inpatient care within a facility or outpatient care at home. Typically, Medicare will help pay for rehab and other kinds of post-acute care.
What Is Post-Acute Care?
Post-acute care simply refers to medical services that you receive after a more serious illness or injury.
The Medicare guidelines for inpatient rehabilitation and outpatient care include coverage for medically necessary post-acute services. The term “medically necessary” applies to services or supplies needed to diagnose and treat covered health issues.
- If you suffer acute symptoms of congestive heart failure, you might get admitted to the hospital to get symptoms and vital signs under control. Once the medical staff has managed acute symptoms, your doctor may release you but prescribe visits from physical therapists and nurses to help you regain your strength and to monitor your condition.
- If you fall and break a bone, hospital treatment may end when the doctor decides that you’re healing on schedule. He or she may still send you to a rehabilitation hospital for therapy and pain management until you’re ambulatory enough to return home.
How Does Medicare Coverage for Rehab Work?
Typically, Medicare Part A pays for post-acute care, even if you get your services at home. Keep in mind that Medicare typically only pays up to 80% of the costs, after deductibles and copays.
Rehabilitation services provided in post-acute care can typically include:
- Physical, occupational, and other kinds of therapy
- Pain, wound, medication, and other nursing management
- Monitoring of vital signs and patient wellbeing
How Long Does Medicare Pay for Rehab?
Medicare coverage for rehab as an inpatient is limited to a specific length of time, and out-of-pocket costs can vary based on how long you’re there for.
The guidelines are:
- For the first 60 days, you have a $1,408 deductible in 2020.
- For days 61 through 90, you have a $352 daily coinsurance amount in 2020.
- After 90 days, you have a $704 coinsurance payment for each lifetime reserve day in 2020. When your lifetime reserve days are exhausted, you’re responsible for the entire cost. Medicare beneficiaries each have 60 lifetime reserve days.
Outpatient service costs may vary. For instance, for such services as outpatient physical or occupational therapy, Medicare Part B pays 80 percent of the costs for medically necessary therapy. There’s no out-of-pocket maximum, so if you have Original Medicare alone, you could be responsible for high costs.
Can Medicare Supplements or Medicare Advantage Plans Help Reduce Costs?
Medicare Supplements and Medicare Advantage plans can reduce and in some cases, eliminate out-of-pocket medical expenses for Medicare beneficiaries.
Medicare Supplement Plans and Post-Acute Care
Depending on the plan you choose, your Medicare Supplement may cover Medicare Part A and B deductibles, coinsurance, or copays. In some cases, you may have no out-of-pocket charges for covered services. These plans are secondary to Medicare, so if Medicare pays, the supplement will as well.
Medicare Advantage Plans and Post-Acute Care
Medicare Advantage plans are primary instead of Medicare, and their coverage varies. They generally offer more affordable copays and deductibles for covered services than just Medicare alone. Medicare Advantage plans also have annual out-of-pocket maximums, so you never have to pay more than this limit for any covered and approved services you get within the year.
Overall, your costs with Original Medicare alone can be high, even if your services are covered. It’s wise to consider another form of coverage to help reduce the chances that you’ll be stuck with hefty out-of-pocket costs.
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.