Medicare Coverage Information for Short Term Rehabilitation
Most admissions to a SNF (Skilled Nursing Facility) for short term rehabilitation, will come on the heels of a 3 night stay at the hospital.
Whereas Medicare HMO’s don’t make this a prerequisite for coverage benefits, traditional Medicare does.
With your Medicare eligibility, you are entitlements include up to 100 days (per “spell,” not annually and subject to renewal, so long as the patient has a 60-day “wellness break,” whereby Medicare is not being billed for rehab and the patient has not had a re-admission to the hospital) for in-patient rehabilitation and subject to certain qualifying criteria (including the minimum 3 night hospital stay as an in-patient only and not for someone who is there under observation).
Medicare covers the first 20 days in full and thereafter (days 21-100), Medicare covers 80% of applicable fees and there is a balance co-pay of $164.50 which is picked up by a secondary or supplemental plan, or paid for out of pocket (if the patient does not have a supplemental policy).
Who is eligible for Medicare?
People with Medicare are covered if they meet all of these conditions:
- You have Part A and have days left in your benefit period.
- You have a qualifying hospital stay.
- Your doctor has decided that you need daily skilled care given by, or under the direct supervision of, skilled nursing or therapy staff. If you’re in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week, as long as you need and get the therapy services each day they’re offered.
- You get these skilled services in a SNF that’s certified by Medicare.
- You need these skilled services for a medical condition that was either:
Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you’re getting observation services in the hospital, you’re considered an outpatient—you can’t count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay. Find out if you’re an inpatient or an outpatient.