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You must pay the inpatient hospital deductible for each benefit period. There's no limit to the number of benefit periods. : Days 1-60: $1,632 ($1,676 in 2025) deductible.*. Days 61-90: $408 ($419 in 2025) each day. Days 91 and beyond: $816 ($838 in 2025) each day while using your 60 “. lifetime reserve days.
- Speech-Language Pathology
Or, they may recommend services that Medicare doesn’t cover....
- Inpatient Hospital Care
Inpatient rehabilitation facilities; Inpatient psychiatric...
- Speech-Language Pathology
- Overview
- Does Medicare cover inpatient rehabilitation?
- What costs should you expect to pay?
- What services will Medicare cover during rehab?
- What are the guidelines for Medicare coverage?
- What is inpatient rehabilitation care?
- The takeaway
•Original Medicare (Part A and Part B) will pay for inpatient rehabilitation if it’s medically necessary following an illness, injury, or surgery once you’ve met certain criteria.
•In some situations, Medicare requires a 3-day hospital stay before covering rehabilitation.
•Medicare Advantage plans also cover inpatient rehabilitation, but the coverage guidelines and costs vary by plan.
Recovery from some injuries, illnesses, and surgeries can require a period of closely supervised rehabilitation. Medicare covers your treatment in an inpatient rehabilitation facility as long as you meet certain guidelines.
Medicare Part A covers your inpatient care in a rehabilitation facility as long as your doctor deems it medically necessary. In addition, you must receive care in a facility that’s Medicare-approved.
Depending on where you receive your inpatient rehab therapy, you may need to have a qualifying 3-day hospital stay before your rehab admission. We’ll discuss that rule in more detail later.
If you’re enrolled in original Medicare (Medicare Part A and Part B) in 2020, you’ll pay the following costs during each benefit period:
•Days 1 through 60. You’ll be responsible for a $1,364 deductible. If you transfer to the rehab facility immediately after your hospital stay and meet your deductible there, you won’t have to pay a second deductible because you’ll still be in a single benefit period. The same is true if you’re admitted to a rehab facility within 60 days of your hospital stay.
•Days 61 through 90. During this period, you’ll owe a daily coinsurance amount of $341.
•Day 91 and onward. You’ll pay $682 coinsurance for each of your lifetime reserve days. You have 60 lifetime reserve days. After you’ve used them all, you’re responsible for all costs.
During inpatient rehabilitation, a team of healthcare professionals will work together to help you function on your own again. Your treatment plan will be tailored to your condition but may include:
•assistance with orthotic or prosthetic devices
•occupational therapy
•physical therapy
•psychological services
•social services
Make sure you’re enrolled in Medicare
You can first enroll during a 7-month window called the initial enrollment period. This period starts 3 months before you turn 65 years old and ends 3 months after your birth month. Another opportunity to enroll is during Medicare’s open enrollment period, which is from October 15 to December 7 each year. If you’re considering a Medicare Advantage (Part C) plan, your enrollment period runs from January 1 through March 31 each year. Depending on your situation, you may also qualify for a special enrollment period.
Confirm your initial hospital stay meets the 3-day rule
Medicare covers inpatient rehabilitation care in a skilled nursing facility only after a 3-day inpatient stay at a Medicare-approved hospital. It’s important that your doctor write an order admitting you to the hospital. If you’ve spent the night in the hospital for observation or testing, that won’t count toward the 3-day requirement. These 3 days must be consecutive, and any time you spent in the emergency room before your admission isn’t included in the total number of days. Your discharge day is also not included in the 3-day total. Tip It can be hard to know if you’ve been admitted as an inpatient or how long your stay has been. This might leave you unsure whether you qualify for the 3-day rule. This is a helpful guide for determining your inpatient status. You can use this guide when talking with your doctor to get the information you need.
If you’re having surgery, check Medicare’s 2020 “inpatient only” list
Some surgical procedures always require admission as an inpatient. The 3-day rule does not apply for these procedures, and Medicare will cover your inpatient rehabilitation after the surgery. These procedures can be found on Medicare’s inpatient only list. In 2018, Medicare removed total knee replacements from the inpatient only list. In 2020, Medicare also removed total hip replacements from the list. The 3-day rule now applies to both of those procedures. If you have a Medicare Advantage plan, talk with your insurance provider to find out if your surgery is considered an inpatient-only procedure. Each plan’s coverage rules differ, and knowing whether the 3-day rule applies could save you a lot of money. Tip If you have a Medicare Advantage (Part C) plan, your costs may be higher or lower based on whether your healthcare providers and rehab facility are in network or out of network. Check with your plan before being admitted to a facility to make sure that it’s in network. This will help ensure full coverage and maximum cost savings.
Inpatient rehabilitation is goal driven and intense. You and your rehab team will create a coordinated plan for your care. The primary aim will be to help you recover and regain as much functionality as possible.
Your team will include registered nurses who specialize in rehab care, along with one or more physicians and rehab therapists, depending on your health condition. You might also receive assistance from psychologists, psychiatrists, or social workers who can help with your mental and emotional well-being.
You may work with a physical therapist to:
•rebuild your strength and ability to move
•increase your range of motion
•decrease pain and swelling
Original Medicare and Medicare Advantage plans pay for inpatient rehabilitation if your doctor certifies that you need intensive, specialized care to help you recover from an illness, injury, or surgical procedure.
You might receive inpatient rehabilitative treatment in a dedicated rehab department inside a hospital, at a skilled nursing facility, or at a separate rehabilitation clinic or hospital.
You must meet certain important conditions in order for Medicare to cover your inpatient rehab. You’ll still have to pay for the cost of coinsurance and deductibles, even with Medicare coverage.
While you’re in rehab, your care will be provided by a team that’ll include nurses, doctors, and therapists. They can help you get back on your feet as quickly and as safely as possible.
Inpatient rehabilitation facilities; Inpatient psychiatric facilities; Long-term care hospitals; It also includes inpatient care you get as part of a qualifying clinical research study. If you also have Part B, it generally covers 80% of the Medicare-approved amount for doctor’s services you get while you’re in a hospital.
Apr 24, 2024 · Inpatient rehabilitation, sometimes called IRF, acute care rehab, or rehab, is a hospital that provides intensive therapies under a medical doctor's supervision. People may need an inpatient rehab admission after surgery, illness, or injury. Medicare covers inpatient rehabilitation services under Medicare Part A if certain conditions are met.
Sep 1, 2023 · Medicare Part A primarily addresses the coverage of hospital stays, including inpatient rehabilitation services within a hospital setting. This includes meals to cater to dietary needs, round-the-clock nursing services, all prescribed medications related to inpatient treatment, and other essential services vital for recovery during the inpatient care period.
The 3-day rule for Medicare requires that you are admitted to the hospital as an inpatient for at least 3 days for rehab in a skilled nursing facility to be covered. You must be officially admitted to the hospital by a doctor’s order to even be considered an inpatient, so watch out for this rule. In cases where the 3-day rule is not met ...
People also ask
Does Medicare cover inpatient rehabilitation?
Does Medicare cover inpatient hospital care?
Does Medicare pay for rehabilitation services?
Does Medicare require a doctor to pay for inpatient rehabilitation?
Do I have to pay a deductible for inpatient rehabilitation care?
Does Medicare pay for inpatient mental health care?
Aug 29, 2024 · Medicare covers medically necessary inpatient and outpatient rehabilitation services. If a person needs to stay in the facility to receive rehabilitation, Part A will cover the treatment. A doctor ...
