Nearly 2 million Medicare patients — mostly seniors — enter a short-term rehabilitation center following a hospitalization every year, according to research cited by Kaiser Health News. Sometimes the rehabilitation is planned, such as a short-term stay following joint replacement surgery. Other times, occupational therapy or speech-language pathology services are needed after an unexpected health crisis such as a stroke. Whatever the reason, many seniors and their caregivers are understandably concerned about the therapy’s potential costs needed to return to their daily lives safely and confidently.
For many seniors and their caregivers, navigating the complexities of Medicare coverage — how much Medicare will pay and what it will pay for — can be confusing. We’ve put together a guide to understanding how Medicare can help cover the cost of a parent’s stay at a quality short-term rehabilitation center.
Who Is Covered?
Medicare covers short-term rehab for your senior parent when his or her doctor requires ongoing medical supervision and care coordination to rehabilitate from surgery or other hospitalization. Also, your mom or dad would need to:
- Have days left in her or his current Medicare Part A benefits coverage period; and
- Be admitted to a Medicare-certified skilled nursing facility for at least three days.
What Is Covered?
- A shared room, unless a private room is deemed medically necessary
- Professional nursing care
- Meals
- 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 patients must pay a $1,408 deductible to cover up to 60 days in a short-term rehabilitation center. However, if your parent has already paid a deductible for a prior hospitalization within the same benefit period, such as when the patient is transferred directly from an acute care hospital.
Beyond the 60-day time period, Medicare currently requires:
- $352 coinsurance each day for Days 61-90
- $704 coinsurance each “lifetime reserve day” for Days 91 and beyond (up to 60 days over your parents’ lifetimes)
Once the lifetime reserve days are used, you or your parent will be responsible for the full cost of rehab.
Remember, a short-term rehabilitation center may suggest medication, services, or procedures which are not covered by Medicare Part A, so make sure you know for certain that an expense is covered — either by Medicare or, if available, a supplemental private insurance plan, before agreeing to the treatment.
Are there any therapy cap limits?
Medicare no longer places a cap on physical therapy costs covered. If your parent needs ongoing rehab on an outpatient basis, it is covered under Medicare Part B. Once the Medicare Part B deductible is paid — $198 for 2020 — then Medicare pays 80%. The patient is responsible for paying the remaining 20%, plus 100% of additional costs beyond the approved amount Medicare will pay.
In addition, when therapy costs exceed a certain threshold, which is $2,080 for 2020, your therapist must confirm that the services being provided remain medically necessary.
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 financially responsible for the full amount of treatment.
You can learn more about the benefits of your Medicare policy on the official Medicare website. For more about your short-term rehab options, including details about our premier Cincinnati retirement community, download our Short-Term Rehab Guide or fill out an information request form.
