People over age 65 who are eligible for Medicare health care benefits often overlook important long term rehabilitation coverage options when choosing their Medicare plan. It is important to understand all the parts of Medicare coverage and the options you have to receive this coverage.
Medicare Parts A and B
Part A of a person’s Medicare plan is often referred to as “free Medicare” or “hospital insurance.” Part A covers hospitalization, lab tests and skilled nursing care under limited circumstances.
Medicare recipients pay for their Part B, which is commonly referred to as “medical insurance.” Generally, the cost is $144.40 per month. If you are receiving social security, this amount is generally withheld from your monthly social security check. Part B covers medically-necessary services such as doctors' services and ordered tests, outpatient care, prescribed home health services, some durable medical equipment and other medical services.
Other Medicare Coverage Options
Even if you elect both Parts A and B, you still will not receive 100% coverage of medical services. In order to cover the remaining hospital and medical expenses, some people add “Medigap” coverage. Depending on the Medigap plan chosen, coverage can include a portion or all of the gaps found in parts A and B.
To better coordinate their medical services, many people purchase a Medicare Advantage Plan rather than keeping their original Medicare (Parts A and B). Be aware that benefits, deductibles and services covered under advantage plans change each year, even if you stay with the same company (e.g., Blue Cross Blue Shield).
Coverage for Rehabilitation Stays
As you review your plan choices each year, it is important to consider how your Medicare or Advantage Plan covers long-term care in a skilled nursing home for sub-acute rehabilitation services. Sub-acute rehabilitation takes place after a qualified hospital stay if a person is not able to safely return home and is in need of rehabilitation services. Traditional Medicare Part A covers up to 100 days of sub-acute rehabilitation at a skilled nursing facility. The first 20 days are covered at 100%, and days 21-100 have a copay of $176 per day (2020 defined amount, adjusted every year). An extended rehabilitation stay could end up costing thousands of dollars without appropriate coverage.
Review Your Plan Every Year
Everyone with a traditional Medicare or an Advantage Plan should review their plan each year to understand plan changes and ensure that the plan still meets their medical service needs. During the annual review, individuals must understand their copays, out-of-pocket costs and their plan’s coverage for everything from hospitals to sub-acute rehab stays. Working with your Medicare insurance professional and elder law attorney could be the best investment you make.
