After a major surgery, serious health event, or long stay in a hospital, many seniors require physical therapy, occupational therapy, or speech-language pathology services resulting to help get them back on their feet and able to navigate their daily lives safely and with ease. When it comes to paying for this kind of short term rehab care, however, many families have questions and concerns about how they will be able to afford the costs of therapy for an elderly parent.
For many seniors and their caregivers, Medicare is the best option for assistance in covering the expense, but understanding just how much Medicare will pay, and what it will pay for, can be confusing. To help you better understand how Medicare covers short term rehab, we put together a simple and straightforward guide to understanding how Medicare can help you cover the cost of a parent’s short term care at a quality rehab center.
Who is covered?
In order to qualify for Medicare coverage, mom or dad needs to be:
- An inpatient who has days left in his or her current Medicare Part A benefits coverage period.
- Admitted to a Medicare-certified SNF for at least three days.
- Medically required to have daily professional medical care.
What is covered?
Medicare Part A will cover:
- A shared room
- Professional nursing care
- Medication and medical supplies
- Dietary consultations
- Medical-related social services
- Medically required speech, physical, and occupational therapy
- Required medical transportation
- Various other medical-related expenses
How much will Medicare Part A pay?
Medicare Part A will cover the costs of approved expenses for a qualifying patient who is admitted to a short term rehab center. According to the current Medicare regulations, Medicare Part A will pay:
- For everything the first 20 days of qualifying care during a benefit period.
- Expenses over $157.50 per day for days 21 - 100 of the required stay.
- Nothing for after day 100. On day 101 of the initial admission period, you or your parent will be responsible for the full cost of rehab.
Remember a short term rehab center may suggest medication, services, or procedures which are not covered by Medicare, so make sure you know for certain that an expense is covered before agreeing to the treatment.
Are there any therapy cap limits?
Yes. As of 2015, the current therapy cap limits are:
- A combined limit of $1940 for physical therapy and speech-language pathology services, and
- A limit of $1940 for occupational therapy.
When an elderly adult’s medical condition requires ongoing therapy which will exceed his or her current therapy cap, it is possible to request an exemption to the limits. If this exemption is granted, your parent’s medical provider must confirm that all ongoing therapy continues to be medically necessary and reasonable. However, Medicare will only cover a total of $3700 for the cost of these ongoing therapeutic services.
It is important to note that Medicare only helps to cover required medical therapies. Any non-essential therapies are not covered, and it is the responsibility of your provider to complete an "Advance Beneficiary Notice of Noncoverage" (ABN)" agreement before performing any uncovered therapies. Once the agreement is signed, you will become financial responsible for the full amount of therapy.
How much will I have to pay for approved outpatient treatment?
Medicare will cover 80% of the Medicare-approved amount of covered therapy. This leaves you to pay for 20% of the approved amount, and since the cost of the therapy is often higher than the approved amount Medicare will pay, 100% of the additional cost. When you enroll in Medicare Part B, you are reimbursed for these additional expenses up to your therapy cap limit.
You can learn more about the benefits of your Medicare policy on the official Medicare website.