Medicare’s open enrollment period is just a few weeks away, and it is not too early to start thinking about your coverage options. One benefit area that Medicare recipients often overlook is long term rehabilitation coverage. 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.” For most people, the cost is $164.90 per month in 2023. If you are receiving social security benefits, 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 Coverage Options
Even if you elect both Part A and Part B, you still will not receive 100% coverage of medical services. In order to cover the remaining hospital and medical expenses, some people add Medicare supplement insurance plans, also known as “Medigap” coverage. Depending on the Medigap plan chosen, coverage can include a portion of or all of the gaps found in Parts A and B.
To better coordinate their medical services, many people purchase a Medicare Advantage plan (often known as Part C) rather than keeping their original Medicare (Parts A and B). Be aware that benefits, deductibles and services covered under Medicare Advantage plans change each year, even if you stay with the same company (e.g., Blue Cross Blue Shield).
Rehabilitation Coverage
As you review your plan choices each year, it is important to consider how your Medicare or Medicare 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 co-pay of $200 per day (2023 defined amount, adjusted every year). You would be responsible for all costs after day 100. 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 Medicare Advantage plan should review their plan every year to understand plan changes and ensure that the plan still meets their medical service needs. During the annual review, individuals must understand their co-pays, out-of-pocket costs and their plan’s coverage for everything from hospitals to sub-acute rehabilitation stays. Working with your Medicare insurance professional and your elder law attorney could be the best investment you make.
