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In this segment, Jennifer Fuller provides important information that can help you or a loved one understand your Medicare benefits, and how Medicare can help pay for Short-Term Rehabilitation when you need it.
Know Your Medicare Benefits for Short -Term Rehabilitation
Featuring:
Jennifer Fuller
Jennifer Fuller is the Vice President of Clinical Reimbursement for The Alden Network. Transcription:
Melanie Cole (Host): Understanding Medicare can be quite confusing for most anyone. Do you know your Medicare benefits for short term rehabilitation? My guest today is Jennifer Fuller. She’s the vice president of clinical reimbursement for the Alden Network. The Alden Network has nearly 30 short-term rehabilitation and post-acute care centers throughout Chicagoland and southern Wisconsin. Welcome to the show Jennifer. Thanks for joining me today to talk about Medicare. Let’s start with a little lesson. Tell the listeners what is Medicare?
Jennifer Fuller (Guest): Thanks for having me Melanie. At the age of 65, most working Americans are entitled to Medicare which is a federally funded health insurance program that guarantees their health insurance coverage.
Melanie: So, who is eligible for Medicare?
Jennifer: The eligibility for Medicare is divided into four groups. The first group is Americans who are 65 or older, who have been working for at least 10 years. The second group of eligibility are Americans who have been receiving Social Security disability benefits for at least two years. Thirdly, we have Americans who might have something known as end-stage renal disease which is a disease that affects your kidneys and lastly, Americans who have ALS which is more commonly known as Lou Gehrig’s disease.
Melanie: Medicare can be quite confusing as I said in the intro Jennifer, so what types of coverage does Medicare offer? Give us a little Medicare lesson here.
Jennifer: Yes, to seniors, Medicare can definitely be confusing. Medicare has four different types of coverage. The first is Medicare part A and that covers your hospital care, care in a short-term rehab center, hospice care and home health services. Then we move into Medicare part B which covers medically necessary services and preventive services, like outpatient services at the hospital, radiology and x-ray, blood draws and other labwork, your physician’s office visits and testing, outpatient therapy, health screenings and vaccines, ambulance transports and other services similar to those.
Medicare part C is also known as the Medicare Advantage Plan. And this is offered by private insurance companies and works similarly to Medicare part A and part B, but it is managed by an insurance company. And finally, we have Medicare part D which is your prescription drug coverage.
What we are talking about today, is Medicare part A and that’s the Medicare plan that covers short-term rehabilitation and post-acute care.
Melanie: That was an outstanding description Jennifer of what Medicare entails. So, now you mentioned that Medicare part A is the plan that covers short-term rehabilitation and post-acute care. So, what are those? Explain that to listeners.
Jennifer: Short-term rehab and post-acute care are nursing care, therapy and other medical programs and services that patients can qualify for after a hospitalization to help them more fully recover from an injury, surgery or other medical condition that they have. It’s a benefit under Medicare part A that we think at Alden, more people should know about and take advantage of, since it’s a benefit that can help someone after a hospitalization get back on their feet and more fully recover and regain strength prior to returning home.
Melanie: Is there a limit to the Medicare benefit and payments for short-term rehabilitation?
Jennifer: Medicare covers a short-term rehab center for up to 100 days as long as you meet Medicare’s requirements. And the first 20 days of that 100 days are actually paid in full by Medicare.
Melanie: Paid in full? Really?
Jennifer: Yeah. Paid in full by Medicare. But what’s important to remember is that days 21-100 do have a co-insurance rate of $167.50 per day that is the patient’s responsibility. However, if a patient has a Medicare supplemental insurance policy, that might pay for some or all of this co-insurance payment.
Melanie: So, why don’t consumers know more about these centers and what they offer?
Jennifer: Consumers rely a lot upon what their doctors tell them. And many doctors today, unfortunately, don’t inform their patients in the hospital all of their options for care after hospitalization. And many doctors in my opinion, aren’t aware of the high quality of care that providers such as Alden and others provide for patients after hospitalization prior to going home.
Melanie: So, they go home after a hospital stay?
Jennifer: Not all patients have to go home after a hospital stay. It’s really an individual choice. And if they have Medicare and or insurance, they do qualify for short-term rehabilitation stays. Medicare and most insurance actually offer those benefits and then we feel that consumers should be more aware of those benefits and able to take advantage of them. At Alden, we have developed five questions to help people decide whether or not to go home after a hospitalization or if they feel that they should go to a short-term rehab center.
Melanie: Jennifer, do you mind sharing the five questions that you have to help people decide whether they should go home after a hospital stay or go straight to short-term rehabilitation center?
Jennifer: No, not at all. At Alden, we understand that choosing whether to go home from the hospital or to go to a post-acute rehab center may a difficult decision to make since going home and being comfortable in your own home is really appealing to patients. When a patient is hospitalized, it’s usually unexpected, so a lot of things are happening to them at that particular time and they are forced to make a lot of decisions in a short time period that they may not be prepared to make. So, Alden has developed these five questions to help people decide whether they should go to a short-term rehabilitation center or whether they go home. These five questions are:
1: Do I have someone at home that’s willing and able to safely care for me 24 hours a day?
2: Do I need therapy a few days a week, which is likely what I would be receiving if I went home or do I need therapy almost daily, which is what I would get in a short-term rehabilitation center?
3: The third question is will I really do these exercises at home in between my therapy visits or would I do better with a skilled therapist helping me making sure that I do the exercises that I am given properly which would happen at a short-term rehab center?
4: What are my short and long-term recovery goals and where can I best meet those goals?
5: Do I suffer from other medical conditions that require close monitoring and would it be helpful for me to be in a short-term rehabilitation center to monitor those medical needs?
Going to a short-term rehab center after a hospital stay to receive therapy and care can improve the likelihood of catching new or recurring problems early on and treating them in that facility and preventing further hospitalizations. If you are a fairly healthy individual with a support system in place that includes loved ones being able to care for you in home; then the choice is easy for you. However, if you are like most people; you may benefit from a little extra care and attention and more frequent therapy that will get you better and stronger before returning home.
Melanie: So, how long is a typical short-term rehab stay?
Jennifer: It’s really based on the individual. It can be a short as a few days to as long as a few weeks depending on what that person needs to achieve their maximum independence after their surgery, their illness or condition. We work with the patient and the patient’s physician to tailor a plan of care to determine how much therapy they need to determine how long that they will be at the facility. And again, it all depends on the person’s health and wellbeing and what their individual personal goals are for returning home.
Melanie: So, are short-term rehabilitation centers nursing homes?
Jennifer: That’s a great question. We get asked that quite a bit. And no, they are not nursing homes. Short-term rehabilitation centers don’t look and feel like a nursing home because they are not designed that way. They look more like fine hotels and they have added benefits of offering care and therapy to someone while they get better.
Melanie: Jennifer what are the differences between short-term rehabilitation centers? What should some look for when choosing a short-term rehab center?
Jennifer: Short-term rehabilitation centers like those offered by Alden and other quality providers will offer luxurious hotel like surroundings, fine dining, state of the art therapy programs and equipment with certified therapists, intensive therapy programs for people to get back on their feet and good nursing care to get them home quickly and safely as possible. Alden and other providers like us offer everything and more that a person needs to recover, so they don’t have to worry about anything and they can instead focus on their therapy and getting back home safely.
Melanie: Thank you so much Jennifer, for all this great information today about short-term rehabilitation benefits offered by Medicare and most insurance plans. It’s a great benefit people can take advantage of when they need it and it’s really been great information. Thank you so much. You’re listening to the Alden Network podcast. Tune in for future podcasts such as Medicaid coverage, memory care for your loved one, home health services and benefits and much more. For more information on your Medicare benefits and short-term rehabilitation coverage or to hear more of these podcasts, go to www.thealdennetwork.com/podcasts , that’s www.thealdennetwork.com/podcasts. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Understanding Medicare can be quite confusing for most anyone. Do you know your Medicare benefits for short term rehabilitation? My guest today is Jennifer Fuller. She’s the vice president of clinical reimbursement for the Alden Network. The Alden Network has nearly 30 short-term rehabilitation and post-acute care centers throughout Chicagoland and southern Wisconsin. Welcome to the show Jennifer. Thanks for joining me today to talk about Medicare. Let’s start with a little lesson. Tell the listeners what is Medicare?
Jennifer Fuller (Guest): Thanks for having me Melanie. At the age of 65, most working Americans are entitled to Medicare which is a federally funded health insurance program that guarantees their health insurance coverage.
Melanie: So, who is eligible for Medicare?
Jennifer: The eligibility for Medicare is divided into four groups. The first group is Americans who are 65 or older, who have been working for at least 10 years. The second group of eligibility are Americans who have been receiving Social Security disability benefits for at least two years. Thirdly, we have Americans who might have something known as end-stage renal disease which is a disease that affects your kidneys and lastly, Americans who have ALS which is more commonly known as Lou Gehrig’s disease.
Melanie: Medicare can be quite confusing as I said in the intro Jennifer, so what types of coverage does Medicare offer? Give us a little Medicare lesson here.
Jennifer: Yes, to seniors, Medicare can definitely be confusing. Medicare has four different types of coverage. The first is Medicare part A and that covers your hospital care, care in a short-term rehab center, hospice care and home health services. Then we move into Medicare part B which covers medically necessary services and preventive services, like outpatient services at the hospital, radiology and x-ray, blood draws and other labwork, your physician’s office visits and testing, outpatient therapy, health screenings and vaccines, ambulance transports and other services similar to those.
Medicare part C is also known as the Medicare Advantage Plan. And this is offered by private insurance companies and works similarly to Medicare part A and part B, but it is managed by an insurance company. And finally, we have Medicare part D which is your prescription drug coverage.
What we are talking about today, is Medicare part A and that’s the Medicare plan that covers short-term rehabilitation and post-acute care.
Melanie: That was an outstanding description Jennifer of what Medicare entails. So, now you mentioned that Medicare part A is the plan that covers short-term rehabilitation and post-acute care. So, what are those? Explain that to listeners.
Jennifer: Short-term rehab and post-acute care are nursing care, therapy and other medical programs and services that patients can qualify for after a hospitalization to help them more fully recover from an injury, surgery or other medical condition that they have. It’s a benefit under Medicare part A that we think at Alden, more people should know about and take advantage of, since it’s a benefit that can help someone after a hospitalization get back on their feet and more fully recover and regain strength prior to returning home.
Melanie: Is there a limit to the Medicare benefit and payments for short-term rehabilitation?
Jennifer: Medicare covers a short-term rehab center for up to 100 days as long as you meet Medicare’s requirements. And the first 20 days of that 100 days are actually paid in full by Medicare.
Melanie: Paid in full? Really?
Jennifer: Yeah. Paid in full by Medicare. But what’s important to remember is that days 21-100 do have a co-insurance rate of $167.50 per day that is the patient’s responsibility. However, if a patient has a Medicare supplemental insurance policy, that might pay for some or all of this co-insurance payment.
Melanie: So, why don’t consumers know more about these centers and what they offer?
Jennifer: Consumers rely a lot upon what their doctors tell them. And many doctors today, unfortunately, don’t inform their patients in the hospital all of their options for care after hospitalization. And many doctors in my opinion, aren’t aware of the high quality of care that providers such as Alden and others provide for patients after hospitalization prior to going home.
Melanie: So, they go home after a hospital stay?
Jennifer: Not all patients have to go home after a hospital stay. It’s really an individual choice. And if they have Medicare and or insurance, they do qualify for short-term rehabilitation stays. Medicare and most insurance actually offer those benefits and then we feel that consumers should be more aware of those benefits and able to take advantage of them. At Alden, we have developed five questions to help people decide whether or not to go home after a hospitalization or if they feel that they should go to a short-term rehab center.
Melanie: Jennifer, do you mind sharing the five questions that you have to help people decide whether they should go home after a hospital stay or go straight to short-term rehabilitation center?
Jennifer: No, not at all. At Alden, we understand that choosing whether to go home from the hospital or to go to a post-acute rehab center may a difficult decision to make since going home and being comfortable in your own home is really appealing to patients. When a patient is hospitalized, it’s usually unexpected, so a lot of things are happening to them at that particular time and they are forced to make a lot of decisions in a short time period that they may not be prepared to make. So, Alden has developed these five questions to help people decide whether they should go to a short-term rehabilitation center or whether they go home. These five questions are:
1: Do I have someone at home that’s willing and able to safely care for me 24 hours a day?
2: Do I need therapy a few days a week, which is likely what I would be receiving if I went home or do I need therapy almost daily, which is what I would get in a short-term rehabilitation center?
3: The third question is will I really do these exercises at home in between my therapy visits or would I do better with a skilled therapist helping me making sure that I do the exercises that I am given properly which would happen at a short-term rehab center?
4: What are my short and long-term recovery goals and where can I best meet those goals?
5: Do I suffer from other medical conditions that require close monitoring and would it be helpful for me to be in a short-term rehabilitation center to monitor those medical needs?
Going to a short-term rehab center after a hospital stay to receive therapy and care can improve the likelihood of catching new or recurring problems early on and treating them in that facility and preventing further hospitalizations. If you are a fairly healthy individual with a support system in place that includes loved ones being able to care for you in home; then the choice is easy for you. However, if you are like most people; you may benefit from a little extra care and attention and more frequent therapy that will get you better and stronger before returning home.
Melanie: So, how long is a typical short-term rehab stay?
Jennifer: It’s really based on the individual. It can be a short as a few days to as long as a few weeks depending on what that person needs to achieve their maximum independence after their surgery, their illness or condition. We work with the patient and the patient’s physician to tailor a plan of care to determine how much therapy they need to determine how long that they will be at the facility. And again, it all depends on the person’s health and wellbeing and what their individual personal goals are for returning home.
Melanie: So, are short-term rehabilitation centers nursing homes?
Jennifer: That’s a great question. We get asked that quite a bit. And no, they are not nursing homes. Short-term rehabilitation centers don’t look and feel like a nursing home because they are not designed that way. They look more like fine hotels and they have added benefits of offering care and therapy to someone while they get better.
Melanie: Jennifer what are the differences between short-term rehabilitation centers? What should some look for when choosing a short-term rehab center?
Jennifer: Short-term rehabilitation centers like those offered by Alden and other quality providers will offer luxurious hotel like surroundings, fine dining, state of the art therapy programs and equipment with certified therapists, intensive therapy programs for people to get back on their feet and good nursing care to get them home quickly and safely as possible. Alden and other providers like us offer everything and more that a person needs to recover, so they don’t have to worry about anything and they can instead focus on their therapy and getting back home safely.
Melanie: Thank you so much Jennifer, for all this great information today about short-term rehabilitation benefits offered by Medicare and most insurance plans. It’s a great benefit people can take advantage of when they need it and it’s really been great information. Thank you so much. You’re listening to the Alden Network podcast. Tune in for future podcasts such as Medicaid coverage, memory care for your loved one, home health services and benefits and much more. For more information on your Medicare benefits and short-term rehabilitation coverage or to hear more of these podcasts, go to www.thealdennetwork.com/podcasts , that’s www.thealdennetwork.com/podcasts. This is Melanie Cole. Thanks so much for listening.