Medicare is sometimes difficult to understand. Rock Creek Health & Rehab, which will open this summer at 1414 College Street in Sulphur Springs, has provided the following information to help Medicare beneficiaries understand their benefits.
First 20 days covered at 100 percent
Did you know that in most cases if you have been in the hospital, Medicare will cover 100 percent of the first 20 days spent at a rehab center like Rock Creek Health & Rehab? That means that if you have been in the hospital (see qualifying stay information below) and need physical, speech, or occupational therapy and in some cases additional skilled nursing, that Medicare will pay 100 percent of the charges for the number of days under 20 that have not already been used in a sub-acute facility (nursing home rehab center) during your specific benefit period.
A separate unit
Most nursing homes, Rock Creek Health & Rehab for example, have separate rehabilitation centers connected to their buildings (we will refer to these as sub-acute rehab centers). What this means to you is that there will be other people there that are close to your age that probably share some of your interests and health-related goals. Many of the people in the rehab centers are those who are recovering from surgery, stroke or other illness who are planning to return home. Most times these are separate, specialized and fully staffed facilities. At Rock Creek Health & Rehab, a separate entrance, large rehab gym, kitchenette, and private dining room set the stage for full-time physical, speech and occupational therapists. Plus, private rooms are offered. The days you spent in the hospital do not count against your first 20 days at a sub-acute rehab center. What that means to you is that you can receive additional medical services following your hospital stay that can get you back on your feet quicker with reduced risk of another injury or illness.
Plus, if you go home from the hospital or an acute rehab center (in a hospital setting), you have 30 days in which to enter a sub-acute rehab center and Medicare will cover the first 20 days at 100 percent if you still have a “skilled need.” This means you need further care for the same condition treated in the hospital. This is called the Medicare Window.
Medicare coverage at sub-acute rehab center patients is for recuperative and rehabilitative care, and is, therefore, a short-term program. Remember that each individual’s situation is different, so please review the following general requirements for a Medicare stay:
- Have valid Medicare card
- Have a minimum 3-day prior hospital stay
- Be admitted to a Medicare-certified bed within 30 days of hospital discharge
- Need further care for the same condition treated in the hospital
- Services must be reasonable and necessary for the condition
- Doctor must certify that skilled services performed by a licensed professional are required daily
- Have Medicare days available (up to 100 days are allowed per benefit period)
Up to 100 days
In some cases, patients stay more than 20 days at a sub-acute rehab center. If further care is needed, Medicare will pay approximately 80 percent of the charges for up to 80 more days (a total of 100 days). The remaining approximate 20 percent is paid by the patient, co-insurance, or through Medicaid.
Rock Creek Health & Rehab is a 120-bed facility, and will accept Medicare, Medicaid, private pay, and most private insurance. Private and semi-private rooms will be offered. Rock Creek will offer long-term care; short-term rehab with physical, speech, and occupational therapy; hospice care; and respite care. For more information on Medicare benefits, referrals, placement for a loved one, employment, or other matters concerning Rock Creek Health & Rehab, please call 1-800-930-9110.
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