Medicare is the United States’ national health insurance program. Its benefits include hospital insurance (part A), medical service insurance (part B), and prescription drugs (part D). Here, you will learn about Medicare coverage for rehab – including the duration and its requirements.
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How Long Will Medicare Pay for a Rehab Center Stay?
Rehab services are included in part A. This covers inpatient care in hospitals or critical access facilities, skilled nursing facilities, hospice care, and some home health services.
Part A shoulders 100 days of care per medical necessity. You can only receive this benefit, however, if you meet the following statutes:
- You have a preceding inpatient or hospital stay of at least 3 days (discharge day not included)
- The stay is deemed medically necessary and must be part of the treatment plan prescribed by the doctor
- The stay at the skilled nursing facility must result from the diagnosis or cause of the hospital stay
Medicare will not cover rehab if:
- The stay is for another ailment (i.e. wound care) and not because of the need for rehab
- The facility is not skilled, meaning the center only provides custodial, long-term care, or non-skilled services
Should you need to stay in a skilled nursing rehab center, your Medicare will cover the following services:
- Semi-private accommodation
- Skilled nursing care
- Medical supplies and equipment
- Dietary counseling
- Ambulance transportation
- Physical and/or occupational therapy
- Speech and language pathology services
- Medical-social services
- Swing bed services
Although Medicare shoulders the 100 days of stay, it only fully pays the first 20 days. As for the rest of the stay, the patient must shoulder the co-pay of $176 a day. This cost is projected to increase to $185.50 in the year 2021.
Should the patient complete 60 days without the need for skilled nursing care, the clock will be reset. As a result, he/she will be entitled to a full round of rehab benefits (100 days) once again.
What are the Other Medicare Benefits for Alcoholism and Substance Abuse?
Apart from rehab, Medicare also covers other services related to treatment. These include:
- Inpatient care at a psychiatric hospital (up to 190 days for the entire lifetime)
- Outpatient care, including telehealth (80% of the amount)
- Post-hospitalization follow-up
- Patient education
- Opioid treatment program services
- Toxicology testing
- Substance use counseling
- FDA-approved medications such as Naltrexone, Buprenorphine, and Methadone
- Therapy (individual or group)
- Intake activities and assessments
- Prescription drugs during hospital stay/doctor’s office visit (injectable Methadone)
- Outpatient prescription medications (covered by Part D)
- Structured Assessment and Brief Intervention Services – screening, brief intervention, and treatment referral
Who are Eligible to Receive Medicare Part A Coverage?
Although Medicare offers good rehab benefits for its recipients, not everyone could enroll in this program. According to the US Department of Health and Human Services, only the following people are eligible for Medicare:
Those aged 65 and above can get a premium-free coverage for Part A and Part B. This is also the case if the individual or his/her spouse has paid Medicare taxes for 10 years.
Part A is also premium-free. Individuals aged 65 and above can get this, granted that he/she is:
- Receiving (or eligible for) benefits from the Social Security or the Railroad Retirement Board
- Married to an individual with Medicare-covered government work.
Part A can also be bought by younger persons for $252 to $458 a month, given that he/she is:
- Entitled to Social Security or Railroad Retirement Board benefits for 24 months
- A kidney transplant or dialysis patient
Medicare Part B: Covering Mental Health Services
In case Medicare does not cover your rehab facility, you may still get some benefits with Medicare Part B. After all, it covers mental health services, which include:
- Inpatient care for 90 days (cost-free for the first 60 days)
- Outpatient care, including psychotherapy, family counseling, psychiatric evaluation, medication management, prescription drugs, diagnostic tests, preventive visit, and wellness visit
- Partial hospitalization, including occupational therapy and individual patient training/education
Part B covers the services rendered by psychiatrists (or other physicians), clinical psychologists, clinical nurse specialists, clinical social workers, nurse practitioners, and physician assistants.
Apart from hospital service, Part B also recognizes treatments made through the doctor’s/health care provider’s office, outpatient facility, or community mental health center.
More than just financing mental health services, Part B also covers durable medical equipment, ambulance services, clinical research, and limited outpatient medications.
Compared to Part A, the beneficiary needs to pay for Part B. This is often deducted – every month – from the individual’s Social Security, Civil Service Retirement, or Railroad Retirement check. If this is not possible, Medicare will send a premium bill to the recipient every 3 months.
The monthly fee for Medicare Part B ranges from $144.60 to $491.60 a year.
Other Payment Options
If you are not qualified for Medicare, you may pay for your rehab through insurance. The four best entities that cover treatment include United Healthcare, Cigna, Aetna, and BlueCross BlueShield.
The Affordable Care Act, also known as ObamaCare, also pays for a certain amount of rehab treatment. Its coverage may vary from 60% to 90% of the total costs.
Additionally, you may also opt to enroll in state-run rehab. While this is free, the waiting time is often lengthy because of the huge number of applicants.
You can avail of this if you have a preceding hospital stay of 3 days. Additionally, your doctor should deem the rehab medically necessary. To take hold of such benefits, you need to stay in a skilled nursing facility. You will need to pay if you stay in a custodial or long-term treatment center.