Medicare and Rehabilitation Care

Rehabilitation hospitals are specialty hospitals or parts of acute care hospitals that offer intensive inpatient rehabilitation therapy. This kind of care is intended for patients recovering from a serious illness, surgery, or injury and requires a high level of specialized care that generally cannot be provided in another setting.

Common conditions which may qualify for care in a rehabilitation hospital include ;

stroke
spinal cord injury
brain injury.

Hip or knee replacement is not covered by Medicare, especially if you have no other complicating condition.

Medicare-covered services offered by rehabilitation hospitals include:

Medical care and rehabilitation nursing
Physical, occupational, and speech therapy
Social worker assistance
Psychological services
Orthotic and prosthetic services

To qualify for a Medicare-covered stay in a rehabilitation hospital, your doctor must state that this care is medically necessary, meaning you must require all of the following services to ensure safe and effective treatment:

24-hour access to a doctor which means you require frequent, direct doctor involvement, at least every 2-3 days
24-hour access to a registered nurse with specialized training or experience in rehabilitation
Intensive therapy, which generally means at least three hours of therapy per day. You may still qualify if you are not healthy enough to withstand three hours of therapy per day)
And, a coordinated team of providers including, at minimum, a doctor, a rehabilitation nurse, and one therapist

Your doctor must also expect that your condition will improve. That after a rehabilitation hospital stay, you will be able to function more independently. Such as, therapy may help you regain the ability to eat, bathe, and dress on your own, live at home, and/or live with family rather than in a living facility.

If you qualify for Medicare-covered care in a rehabilitation hospital, your out-of-pocket costs will be the same as for any other inpatient hospital stay.

Also keep in mind that if you enter a rehabilitation hospital after being an inpatient at a different facility, you will still be in the same benefit period. If you do not qualify for a Medicare-covered stay in an inpatient rehabilitation hospital, you may still qualify for rehabilitation care from a skilled nursing facility, a home health agency, or in an outpatient setting.

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Medicare Part D Costs for 2020

Before 2006, Medicare did not cover prescription medications. There was a limited number of medications that were offered under Medicare Part Band, and otherwise, you had to pay for your medications out of pocket. In 2003, everything had changed when President George W. Bush passed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). This is what we now know of as Medicare Part D , an optional part of Medicare that provides prescription drug coverage. Part D plans are run by private insurance companies and not by the government. However, the federal government sets guidelines on what basic medications are covered and how much you can be charged. A deductible is the amount of money you spend out of pocket before your prescription drug benefits begin. Your plan may or may not have a deductible. The maximum deductible a plan can charge for 2020 is set at $435. It has increased by $20 from 2019. Part D

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Benefit Period

The benefit period is the length of time during which a benefit is paid. It measures your use of inpatient hospital and skilled nursing facility (SNF) services. This begins the day you are admitted as an inpatient, or to an SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. After you meet your deductible , Original Medicare will pay in full for days 1 to 60 that you are in a hospital. The remaining days, 61-90 , you will have to pay a daily coinsurance. If your 90 days of hospital coverage has been consumed but you need to stay longer, Medicare covers up to 60 additional lifetime reserve days and yo u will also have to pay a daily coinsurance . These days are nonrenewable , meaning you will not get them back when you become eligible for another benefit period. If you run out of days during your benefit period, Medicare will stop paying for your in-patient related hospital costs such as room and board. To be eligible for a new b

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Comparing Health Care Providers

How do I compare the quality fo Health Care Providers? Medicare collects information about the quality and safety of medical care and services given by most health care providers (and facilities). Check Medicare.gov/quality-care-finder and get a snapshot of the quality of care they give their patients. Some feature a star rating system to help you compare quality measures that are important to you. Find out more by: Talking to your health care provider. Each health care provider should have someone you can talk to about quality. Asking your doctor or other health care provider what he or she thinks about the quality of care other providers give. You can also ask your doctor or other health care provider about the quality of care information you find on Medicare.gov . Having access to quality and cost information upfront helps you get a complete picture of your health care options. You'll be able to compare quality ratings, cost information, and other details to hel

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