Making Sense of the Medicare Rehab Benefit

chart discussing medicare

When a central Ohio senior you love is hospitalized for an illness or injury or planning for an upcoming surgery, understanding Medicare will cover rehab to help with their recovery is important. Older adults and adult children may not have had any experience using their Medicare benefits beyond physician appointments and outpatient testing until now. This quick overview should help give you a basic understanding of the benefit.

Medicare Benefit Requirements for Skilled Nursing & Rehab Coverage

The first requirement your older loved one will have is to meet what is known as a “qualifying hospital stay.” What that means is they have to spend 3 consecutive midnights in the hospital at an inpatient level of care. It is important to make sure they were formally admitted to the hospital and not being cared for under an observation stay.

After the qualifying hospital stay, the next requirement is that their physician feels they need to continue receiving skilled nursing and/or rehabilitation care after being discharged. For Medicare to pay for those services, the senior must go to a Medicare-certified post-hospital rehab and care center, such as Whetstone Garden in Columbus or another of the Optalis Healthcare’s central Ohio communities.

How Much Does Medicare Pay for Skilled Nursing & Rehab Care?

Once a senior has met Medicare’s skilled nursing and rehab center eligibility requirements, the next step is to be certain you understand what is covered and for how long. Here are the requirements for 2022.

Days 1-60. For the first 60 days of their stay, Medicare Part A will pay for 100% of their expenses. Coverage includes their room, meals, equipment, most supplies, medications, skilled nursing care, and rehab services performed by physical, occupational, and speech therapists.

Days 61-90. If their physician determines they still need skilled nursing and rehab care after day 60, a daily coinsurance fee of $389 will be charged to the senior. This will continue through day 90.

Days 90 and beyond. While most patients have recovered and returned home before day 90, some people with more complex needs may not. From day 90 on, a daily coinsurance fee of $778 is charged to the senior until they reach their lifetime reserve (up to 60 days over their lifetime) for each benefit period. After the lifetime reserve is reached, patients are responsible for the entire cost of their skilled nursing and rehab stay.

The Medicare 30-Day Rule

On occasion, an older adult may return home after a few weeks of post-hospital rehab care and experience a setback. The physician involved may recommend additional rehab. If that happens within 30 days of their discharge from a skilled nursing and rehab center and they still have days remaining in their Medicare benefit period, they may return to the rehab center without being required to have another 3-night hospital stay.

We hope this quick overview provides you with a better understanding of what to expect from the Medicare skilled nursing and rehab benefit. If you are a central Ohio caregiver searching for rehab care for a senior loved one, please contact us. We will be happy to help!