Medicare Guide

Medicare Guide to your stay at Emerson Health and Rehabilitation Center.

What is Medicare?

Medicare is a federal health insurance entitlement program over seen by the Secretary of Health and Human Services and administered by the Health Care Financing Administration (HCFA).

Does Medicare cover the expense of staying at Emerson Health and Rehabilitation Center?

In order for your rehabilitation stay to be covered by Medicare, you must be entitled to Part A of Medicare and have been in the hospital as an inpatient for at least three overnight stays. At Emerson Health and Rehabilitation Center, we will work with your hospital and your physician to make sure that your stay is covered under the following Medicare guidelines:

  • Placement in a skilled nursing facility is the most appropriate care
  • Skilled services must be ordered and certified by a physician
  • Skilled nursing and / or skilled rehabilitation services must be necessary and provided on a daily basis

How does Medicare work?

Medicare consists of two major parts:

1. Part A: Hospital Insurance

  • Skilled services must be reasonable and necessary for the condition which was treated during the hospital stay, or condition which arose in a skilled nursing facility while being treated for a condition which was previously treated in a hospital
  • The skilled nursing facility must admit the patient within 30 days of hospital discharge and admission must relate to the condition that made the hospital stay necessary
  • Days must be available in the current Benefit Period
    • Medicare uses a period of time called a Benefit Period to keep track of how many days of SNF benefits you use, and how many are still available. A benefit period begins on the day you start using the SNF benefit under Part A of Medicare. You can get up to 100 days of skilled nursing services or rehabilitation.
    • Your benefit period ends
      • When you have not been in a skilled nursing facility for at least 60days in a row, or
      • If you remain in a SNF, when you haven’t received skilled care there for at least 60 days in a row
    • There is no limit to the number of benefit periods you can have. However, once a benefit period ends, you must have another 3-day qualifying stay and meet the Medicare requirements before you qualify for another 100 days of skilled nursing benefits.
    • The first 20 days of the benefit period are fully covered by Medicare.
    • The remaining 80 days have a co-payment. Many secondary insurance companies will often cover this deductible.

Services that Medicare Part A helps to pay for while in a skilled nursing facility:

  • Semi-private room
  • All meals, including any special dietary needs
  • Skilled nursing care
  • Physical, occupational, and speech therapy services
  • Medical social services
  • Medications
  • Medical supplies and equipment used in facility
  • Dietary counseling

Non-Covered Services:

  • Non-skilled or custodial care
  • Personal convenience items
  • Private duty nurses
  • Private room fees, except when a physician certifies that a private room is medically necessary

2. Part B: Medical Insurance

Eligibility Requirements

Medicare B is voluntary. Anyone entitled to Medicare Part A benefits can enroll in Medicare Part B. The program has a monthly premium, annual deductibles and co-insurances. Most United States residents who are age 65 or older can enroll in Part B coverage without having Part A.

Medicare Part B, often referred to as outpatient: or physician’s insurance: helps pay for:

  • Physician services
  • Outpatient hospital services and certain medical supplies, drugs and biologicals (vaccines, serums)
  • Outpatient physical therapy, including occupational and speech
  • Diagnostic testing (x-rays and lab tests)
  • Durable medical equipment
  • Certain prosthetic services
  • Surgical dressings, splints and casts
  • Parental and internal nutrition
  • Certain vaccines including Hepatitis B and Influenza (flu)

Non-covered services include:

  • Routine physical examinations and related tests
  • Routine podiatry services and dental care
  • Examinations to prescribe or fit eyeglasses or hearing aids
  • Most immunizations, prescription drugs or cosmetic surgery, unless needed because of accidental injury or to improve function