The thought of paying for inpatient rehabilitation after a major surgery or debilitating illness is a concern for many seniors. Experienced elder law attorneys often advise clients who face rehabilitation that Medicare Part A will help pay for a portion, sometimes all, of the cost of a stay in an inpatient rehabilitation facility. But, are Medicare benefits available for all seniors? Here’s a quick look at what exactly goes into an inpatient rehab stay, who qualifies for Medicare coverage in such rehabs, and how much of the cost is covered by Medicare:
Inpatient Rehabilitation Centers
Inpatient rehabilitation centers, sometimes referred to as acute care rehabilitation centers or short-term skilled rehabilitation centers, provide physical and occupational therapy to patients who have recently undergone serious surgeries like joint replacements or who have suffered from a stroke, heart attack, or other debilitating illnesses. Inpatient rehabilitation centers may also provide a level of full-time skilled nursing care.
Medicare Coverage Eligibility
Medicare will cover your stay in an inpatient rehabilitation center if your doctor certifies that you meet the following eligibility requirements:
- You need intensive physical or occupational rehabilitation for at least three hours a day, at least five days a week
- You must have round-the-clock access to a skilled rehabilitation nurse
- You are visited at least three times a week by a doctor that specializes in rehabilitation
- You need at least one other type of physical or occupational therapy, such as prosthetic or speech therapy
Even if you are not expected to improve to the point where you can return home, Medicare may still cover your inpatient rehabilitation costs. If your doctor determines that you do not need inpatient rehabilitation but still need care at a skilled nursing facility, or that you only need part-time, in-home skilled nursing care, Medicare may also cover those costs.
How Much Medicare Will Cover
Medicare Part A will cover a stay at an inpatient rehabilitation center for up to 100 days: the first 20 days of your stay at the facility, after which you are responsible for co-pays of $167.50 per day during your next 80 days, which may be covered by supplemental insurance. However, Medicare will only continue to cover rehabilitation care and services if you are progressing in your recovery.
During your stay at an inpatient rehabilitation center, Medicare will pay for a semi-private room, meals, nursing and social worker care, prescriptions and medical equipment, and rehabilitation services.
If you’d like more information about Medicare coverage for inpatient rehabilitation, please contact our office at 877-653-3450 to schedule an initial complimentary consultation.
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