You might be wondering what to do when Medicare runs out for rehab. It’s a common worry because Medicare can be a lifeline, but it doesn’t cover everything forever. Knowing your options is key to getting the care you need without breaking the bank.
Understanding Medicare Coverage for Rehab
Medicare offers coverage for rehab services, but it’s important to know how it works. You have options when it comes to Medicare plans, and each type has its own rules for rehab coverage.
Types of Medicare plans
Original Medicare includes Part A and Part B. Part A covers inpatient rehab in approved facilities while Part B pays for outpatient treatment. Medicare Advantage plans, also known as Part C, must cover the same services as Original Medicare. These plans require you to use in-network providers for mental health care, alcoholism, and substance abuse treatment. There are also Special Needs Plans for people with chronic conditions, including mental illness and substance abuse disorders. These plans may offer better care for those with specific health needs.
Coverage Limits For Inpatient & Outpatient Rehab
For inpatient rehab, Medicare Part A covers your stay if it’s medically necessary. In 2024, you’ll pay a deductible for days 1-60 of each benefit period. From days 61-90, you’ll owe money per day. After day 90, you’ll use lifetime reserve days that cost money too.
Outpatient rehab is covered under Part B. This includes services from doctors, psychiatrists, psychologists, and other mental health professionals. However, Medicare doesn’t cover treatment by licensed professional counselors.
Eligibility Criteria
To get Medicare coverage for inpatient rehab, you need to meet specific requirements. Your doctor must certify that you need intensive rehab, ongoing medical supervision, and care from a team of professionals. You should also have access to a doctor 24/7 and receive therapy for at least 3 hours a day, 5 days a week.
For skilled nursing facility care, you must have a qualifying 3-day inpatient hospital stay before admission. This rule doesn’t apply to certain surgeries on Medicare’s “inpatient only” list. It’s worth noting that time spent under observation doesn’t count toward the 3-day requirement.
Remember, Medicare coverage for rehab isn’t unlimited. It’s designed to help you recover and regain independence. As you plan for your rehab needs, keep these guidelines in mind to make the most of your Medicare benefits.
Signs That Your Medicare Coverage is Running Out
Knowing when your Medicare coverage for rehab is running out is key to planning your next steps. You need to keep an eye on a few things to avoid unexpected costs.
Tracking Your Benefit Period
Your Medicare benefit period starts when you’re admitted to a hospital or skilled nursing facility. It ends after 60 days without inpatient care. If you go back to the hospital within 60 days, you’re still in the same benefit period. But if you return after 60 days, a new period begins. This reset can affect your coverage and costs.
Reaching Coverage Limits
Medicare has strict limits on how long it covers rehab services. For inpatient rehab, YOU ARE RESPONSIBLE for different costs depending on how long your stay lasts. This makes it important to explore other financial options before your coverage runs out.
For skilled nursing facilities, Medicare covers the first 20 days completely. After that, you’ll pay a daily fee for days 21 through 100. Once you hit the 100-day limit, Medicare won’t pay for rehab in a skilled nursing facility, leaving you to cover the full cost.
Options When Medicare Coverage Ends
When your Medicare coverage for rehab runs out, you’re not out of options. There are several ways to continue getting the care you need. Let’s look at some alternatives that might work for you.
Private Health Insurance
If you’re still working or have access to employer-sponsored health insurance, this could be a lifeline. The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to keep your employer’s health insurance for a while after leaving your job. You have 60 days to sign up for COBRA after your work benefits end. It can last 18 to 36 months. Keep in mind, though, that you’ll have to pay the full premium yourself, which can be costly.
Medicaid
Medicaid is a state and federal program that helps with healthcare costs for people with limited income and resources. Each state has its own rules for who can get Medicaid. It’s based on things like your age, if you’re pregnant, if you have a disability, and how much money you make. If you qualify, Medicaid can help pay for rehab at thousands of treatment centers across the country.
Financial Assistance Programs
Some states offer health coverage beyond federal Medicaid. These programs might help you pay for rehab if you meet certain requirements. Also, under the Affordable Care Act, you might be able to get government subsidies to help pay for insurance that covers rehab. These include premium tax credits and cost-sharing subsidies. They’re based on your income and can make insurance more affordable.
Payment Plans
Many treatment centers understand that paying for rehab can be tough. That’s why some offer payment plans or other ways to spread out the cost over time. This can make it easier to afford treatment, even without insurance. Some facilities also use sliding fee scales. This means they adjust the cost based on how much you earn. The less you make, the less you pay. These options can help you get the care you need without costing too much.
You Have Options After Medicare
Managing healthcare costs, especially when Medicare coverage ends, can be challenging. However, by planning ahead and exploring different financial options, you can still get the care you need. It’s important to stay informed and look for solutions that fit your situation. While it may seem difficult, there are resources out there to help you continue your rehab and stay on the path to recovery.
Fabian Ramirez Insurance Agency offers expert Medicare services, helping individuals understand and select the right coverage for their healthcare needs. With personalized guidance, we make navigating Medicare options simple and stress-free. Our team works closely with clients to ensure they receive the best coverage at an affordable price. At Fabian Ramirez Insurance Agency, we are committed to providing reliable and trustworthy Medicare solutions. For more information, please visit Fabian Ramirez Insurance Agency.
