When it comes to figuring out the relationship between post-acute rehabilitation and Medicare, you probably have a lot of questions: Does Medicare cover rehabilitation services? If so, how much does Medicare pay for rehabilitation services? And, more specifically, does Medicare pay for post-acute rehabilitation?
We’re here to break it down for you.
As we age, our bodies may require additional care and support to maintain optimal health and well-being. Rehabilitation services play a crucial role in helping seniors recover from injuries or surgeries or manage chronic conditions.
If you’re a Medicare beneficiary or have a loved one who is, it’s essential to understand what rehabilitation services are covered. So, let’s explore the different types of rehabilitation services covered by Medicare so you can make informed decisions about your healthcare.
What is Medicare?
If you’re unfamiliar, Medicare is a federal health insurance program that provides coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities or specific medical conditions.
The insurance program consists of four parts:
- Part A – Covers hospital stays
- Part B – Covers outpatient services
- Part C – Offers Medicare Advantage plans
- Part D – Covers prescription drugs.
Rehabilitation services are generally covered under Part A and Part B of Medicare, depending on the type of care and setting.
Medicare Coverage of Rehabilitation Services
Before we dig in, it’s important to note that Medicare coverage for rehabilitation services may be subject to certain limitations like coverage limits, deductibles, copayments, and other restrictions. Check with your Medicare or healthcare provider to understand the specific coverage details and requirements for the services you may need.
- Inpatient Rehabilitation Facility Services (Medicare Part A):
If you require intensive rehabilitation services in a hospital setting, Medicare Part A may cover your care in an Inpatient Rehabilitation Facility (IRF). IRFs are specialized facilities that provide rehabilitative services, including physical therapy, occupational therapy, speech-language pathology, and other services under the supervision of a physician.
To qualify for IRF coverage, you must have a condition that requires close medical monitoring and at least three hours of rehabilitation services per day. Medicare Part A generally covers up to 90 days of inpatient rehabilitation care, with the possibility of an additional 60 days with a co-pay.
- Outpatient Rehabilitation Therapy Services (Medicare Part B)
Medicare Part B covers a wide range of outpatient rehabilitation services that can be received in various settings, such as hospitals, skilled nursing facilities, home health agencies, and private offices.
These services may include physical therapy, occupational therapy, and speech-language pathology services to help you regain or maintain your physical and functional abilities.
Medicare Part B generally covers 80% of the Medicare-approved amount for these services, and you are responsible for the remaining 20% after you meet your annual deductible.
- Cardiac Rehabilitation Services (Medicare Part B)
If you have had a heart attack, heart surgery, or have certain chronic heart conditions, Medicare Part B may cover cardiac rehabilitation services.
Cardiac rehabilitation is a comprehensive program that includes exercise training, education, and counseling to help you recover and manage your heart health.
Medicare Part B covers up to 36 sessions of cardiac rehabilitation services over a 36-week period. Eligible beneficiaries may also receive additional coverage for up to 36 sessions of intensive cardiac rehabilitation services over a 12-week period.
- Pulmonary Rehabilitation Services (Medicare Part B)
Medicare Part B also covers pulmonary rehabilitation services for beneficiaries with chronic obstructive pulmonary disease (COPD) or other chronic respiratory conditions.
Pulmonary rehabilitation is a structured program that combines exercise training, education, and support to help you manage your respiratory symptoms and improve your lung function.
Medicare Part B generally covers up to 36 sessions of pulmonary rehabilitation services over a 36-week period. Additional coverage is available for eligible beneficiaries for up to 36 sessions of intensive pulmonary rehabilitation services over a 12-week period.
- Prosthetic Devices & Orthotics (Medicare Part B)
If you require a prosthetic device or orthotic to improve your mobility or function, Medicare Part B may provide coverage.
Prosthetic devices (such as artificial limbs) and orthotics (such as braces or supports) are considered durable medical equipment (DME) and are typically covered at 80% of the Medicare-approved amount under Part B. You may need a prescription from your doctor, and the device must be deemed medically necessary for coverage.
- Home Health Rehabilitation Services (Medicare Parts A & B)
Medicare also covers rehabilitation services that are provided in your home, either through home health agencies or as part of a home health care plan.
Home health rehabilitation services may include physical therapy, occupational therapy, and speech-language pathology services, as well as other skilled nursing care. These services are covered under both Medicare Part A and Part B, depending on the type of care provided.
To be eligible for home health services, you must meet certain criteria, such as being homebound and needing skilled care on an intermittent basis.
- Hospice Care (Medicare Part A)
If you are receiving hospice care for a terminal illness, Medicare Part A covers a wide range of services, including rehabilitation services, to help manage your symptoms and improve your comfort.
Instead of treatments, hospice care provides comfort and support. Rehabilitation services may be included as part of the palliative care provided under hospice.
These services are covered under Medicare Part A, and there is typically no cost-sharing for hospice services.
Rehab at a Skilled Nursing Facility
Medicare will cover inpatient rehabilitation at a skilled nursing facility like Brentwood. This is common after injuries or surgeries like a knee replacement.
Coverage lasts up to 100 days after a qualifying 3-day hospital stay. (If you don’t qualify, Medicare may cover outpatient rehabilitation as previously mentioned.)
For the first 20 days of inpatient rehab, after the Part A deductible is met, you likely won’t have to pay anything. During days 21-100 of the benefit period, there is a per-day charge. If you require additional rehabilitation beyond 100 days, you will have to pay the full cost.
At Brentwood, we work with you and your family to ensure you’re covered for the post-acute rehab services and skilled nursing services we offer. If you’d like to learn more about Medicare and rehabilitation services, reach out today.