Do you find Medicare coverage more than a little confusing? If you answered yes, know that you aren’t alone. The various parts of Medicare and their associated benefits can be tough to understand. One area that recipients often struggle to figure out—and for good reason—is the short-term rehabilitation benefit.
This is the part of Medicare that determines what will and won’t be covered if you need to transition to a senior rehabilitation and recovery program in a skilled nursing facility (SNF). Patients who are hospitalized for an injury, illness, accident or planned surgery can keep working on their recovery at a community such as one of ASC’s more than 90 short-term rehab locations.
So, what are the criteria for Medicare to pay for short-term rehab, and how much will it cover? Here’s an overview of this benefit.
Medicare and Short-Term Rehab Criteria
If you are a senior interested in transferring from the hospital to a skilled nursing facility to participate in a program such as ASC’s Moving Forward Rehabilitation, here’s what you should know about the qualifying criteria:
- Medicare Part A: Also known as hospital insurance, Medicare Part A includes short-term rehabilitation on a limited basis for those who qualify.
- Three-midnights rule: Medicare will cover these services if the patient has had a qualifying inpatient hospital stay of at least three consecutive calendar days, starting with the calendar day of hospital admission but not counting the day of discharge. It’s important to note that a senior must be admitted as an inpatient, not in an observation unit, to qualify.
- Daily skilled care requirement: Another important criterion is that your doctor must certify that you need daily skilled care, such as physical therapy or IV therapy, from or under the supervision of skilled nursing or therapy staff.
- Medicare-certified facility: For short-term rehab to be covered under the benefit, the SNF must be Medicare-certified. You can use the Medicare facility locator tool to confirm whether a provider you are considering using is certified.
You should also take a few minutes to learn more about the coverages and co-pays associated with continuing your recovery in a SNF.
Medicare Patient Liability and Coverage for Rehabilitating in a SNF
Medicare Part A limits a patient’s coverage to 100 days per benefit period. In 2024, for each benefit period, the patient will incur the following co-pays:
- Days 1-20: $0
- Days 21-100: $204 per day
- After day 100: Patient is responsible for all costs
The co-pays listed above apply to traditional Medicare. If you opted in to a Medicare Advantage Plan, these numbers may differ. Check with the plan administrator for your chosen insurance for more information and rates.
Covered services in a skilled nursing facility include, but aren’t limited to:
- A semiprivate room
- Daily meals and snacks
- Around-the-clock skilled nursing care
- Physical, occupational and speech pathology
- Medical social services
- Medications related to your illness or condition
- Medical supplies and equipment used in the facility
- Ambulance services if other forms of transportation would endanger your health
- Dietary counseling and nutrition support
If you or a senior loved one’s physician is recommending a few weeks of short-term rehab after your hospital stay, we can review your Medicare benefit with you and introduce you to our rehab team. Visit Short-Term Rehabilitation
