“How much will it cost me?” is a frequent question when a person is considering any medical service. I recently spoke to a person who resisted calling an ambulance for a life threatening medical episode because of the cost of the service. If you have traditional Med A and B coverage, I hope to help clear up the concern of cost for Short Term Rehabilitation in this blog. For those who have a Medicare Replacement policy, refer to the terms of your policy agreement.
*Medicare Part A covers skilled nursing care provided in a Skilled Nursing Facility in certain conditions for a limited time (on a short term basis) if the following conditions are met.
You have Part A coverage and have days left in your benefit period.
You have a qualifying hospital stay (3 midnights).
Your doctor has decided that you need daily skilled care.
The Skilled Nursing Facility give services that is certified by Medicare.
You need these skilled services for a medical condition that’s either:
-A hospital related medical condition
-A condition that started while you were getting care in the Skilled Nursing Facility for a hospital-related medical condition.*
Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and evaluate your care. Medicare-covered services include, a room, meals, skilled nursing care, therapy (OT, PT, ST needed to meet your goals),medications, medical supplies and equipment used in the facility, and more.
Under traditional Medicare A, a person can come to Premier Rehabilitation for continued short term care and pay $0 out of pocket for the first 20 days, for day 21-100 a daily copay of $170.50 will apply which can be billed to a supplement insurance plan or if you do not have one it will be owed privately. Traditional Medicare B pays 80% of therapy costs. There is a 20% coinsurance for Part B therapy which can be billed to a supplement insurance plan or if you do not have one it will be owed privately.
If you have Medicare Replacement plan (Advantage Plan), benefits will have to be verified with the plan, as each one varies, to determine what is covered. Before entering a Skilled Nursing Facility, make sure they are in network with your insurance plan.
Cost is a concern when medical issues occur, but as you can see, Medicare has benefits to help handle or curb your costs.
If you have questions about Premier Rehabilitation, please contact us at 417-833-0016.
Best in Health,
*Information taken from Medicare.gov*