Persons considering a sub-acute rehabilitation center or long-term care for a loved one or friend need to understand Medicare and its benefits.
Judi Hyde, Medicare coordinator at the Lake Orion Nursing and Rehabilitation Centre, provides the following tips:
1. A person may qualify for Medicare if they are 65 years or older, on disability or have end-stage renal disease or black lung.
2. They may qualify for a sub-acute rehab or long term care facility under Medicare if there is a minimum three-night, in-patient stay at a hospital.
3. Medicare requires an order from the physician stating the patient is in need of skilled nursing care.
4. Skilled care involves receiving skilled services on a daily basis, such as receiving therapy services five days a week for 1-2 hours a day, daily tube feedings, IV therapy or daily wound care.
5. Medicare Part A usually allows up to 100 days of a benefit period if skilled care is needed.
6. New benefit periods may occur after 60 consecutive unskilled days.
7. From day 1 to 20, traditional Medicare may cover 100 percent of the cost. From day 21 to 100, traditional Medicare may cover up to 80 percent leaving a daily copay, which may be covered by a supplemental policy.
8. Medicare covers physical therapy, occupational therapy and speech therapy, if needed.
9. If a person had a three-night hospital stay and is discharged home, he or she may be eligible within 30 days of discharge to qualify for a skilled nursing benefit under traditional Medicare.
10. Medicare Advantage plans or combined Medicare plans may require prior authorization to receive services from a sub-acute rehab or skilled nursing facility, and copay amounts may vary with each policy.
For more information about Medicare, visit www.medicare.gov or call 1-800-633-4227) Or contact Judi Hyde at Lake Orion Nursing and Rehabilitation Centre at 248-693-0505, ext. 165.