What is Medicare?
Medicare is United States federal government comprehensive social insurance scheme that is meant to care for elderly Americans who have reached the age of 65 and above or the few younger persons with serious disabilities. The program is also meant to care for those who suffer from End-Stage Renal Disease also known as “ESRD” which is a permanent kidney failure that requires dialysis or transplant.
The program has been able to provide health insurance to millions of Americans since 1966. In 2010 alone, Medicare was able to provided required health insurance to over forty-eight million Americans among which there are about forty million people who have reached or passed 65 years and eight million younger people with disabilities.
The Medicare health insurance program only provides coverage for medically necessary care. It focuses more on those medical acute cares like hospital stays, doctor visits and drugs. The program is concentrated on short-term services for health conditions that are expected to improve. Medicare will help you pay for a short stay in a professional nursing facility but does not pay the largest part of long-term care services.
Does Medicare Provide Cover For Patients in Rehab?
Medicare provides insurance coverage for patients who are qualified for Medicare-covered care in a rehabilitation hospital. The rehabilitation hospitals include those specialty hospitals that provide intensive inpatient rehabilitation therapy.
However, in this situation, the cost out-of-your-pocket will be the same as for any other hospital stay. You can still enjoy the same benefit period if you were admitted into a rehab hospital after being an inpatient at a different hospital.
Some instances of conditions that may qualify you for Medicare-covered insurance in rehabs includes
- Spinal cord injury
- Brain injury
How Can You Be Approved For Long Term Medicare-Covered Rehab?
There are few conditions that qualifies you for Medicare-covered rehabilitation
- You are on admission on Medicare-certified hospital within thirty days of your recent hospital stay
- You require a special or skilled care like that of nursing services or physical therapy
If you met the above conditions, Medicare will offset your bills for up to a hundred days.
- Medicare pays 100% of your first 20 days bill
- From Day 21 to day 100, you pay for your expenses up to the tune of $140.00 per day while the Medicare will offset any balance.
Some other Medicare-covered services provided by rehab hospitals includes
- Social Worker assistance
- Physical, occupational or speech therapy
- Medical care and rehabilitation nursing
- Orthotic and prosthetic services
- Psychological services
Traditional Medicare vs. Medicare Advantage Plans
How to Enroll? You are automatically enrolled into the “traditional” or the “original” Medicare program when you enroll in the Medicare program for the very first time. On the other hand, if you want to join Medicare Advantage plans, you can do that anytime from October 15 to December 7 of any year.
What They Cover
The original Medicare provides coverage for Part A and Part B. In this program, you only pay standard rates for services not taking into account your location. You simply visit a hospital that accepts Medicare patients in any location in the country. You can also add “Part D” to the coverage by getting yourself enrolled in a private “stand-alone” drug plan.
On the other hand
Medicare Advantage plan provides a good alternative to get the benefits of the program through regional or local private plans, which are mostly “health maintenance organization”. For each plan under Medicare Advantage plan, it must consist of everything that is covered by the original Medicare with more benefits and most of the time the plan includes the Part D drug coverage. Most Medicare Advantage plans do not cost more than traditional Medicare on monthly basis, however some come with a higher per month premium.
The original Medicare policy is clearly stated with what they cover and what you pay, while Medicare Advantage plans looks similar to ordinary “private insurance” that individuals working for themselves buy everyday on open market, because they have varied monthly premiums, coinsurance, copays and limits for out-of-pocket.
Which One Provides the Better Coverage, Original Medicare or Medicare Advantage?
On the surface of it, for a slightly extra cost Medicare Advantage seems to provide the better coverage out of the two. However, while Medicare Advantage plans must offer exactly the same coverage as Traditional Medicare, they can make it difficult to get approved for rehabilition. These plans may approve rehab costs but for a shorter stay and a lower dollar amount of coverage or make one jump through more hoops to get an approval. According to one geriatrician interviewed by the author of this article, this does not happen with Traditional Medicare coverage; the best Medicare coverage available is Traditional Medicare combined with a Medicare Supplemental plan which will cover the Traditional Medicare 20% deductible. However, Medicare Supplemental plans are costly and out of reach for many seniors. Is this case, Medicare Advantage plans offer a cost savings for a healthy senior population. Be sure to compare every item of coverage offered by Medicare Advantage plans before making the switch.
Bear in mind that Medicare Advantage plans are paid approximately $15,000 per patient per year versus approximately $10,500 per patient per year for Traditional Medicare (national average) . The rationale is that private insurers can manage Medicare populations more cost effectively than Medicare itself. Does this make sense? Is it likely to equate to better coverage for you? Or better profits for a private insurer?