• Original Medicare (Part A and Part B) will pay for inpatient rehabilitation if it’s medically necessary following an illness, injury, or surgery once you’ve met certain criteria.
  • In some situations, Medicare requires a 3-day hospital stay before covering rehabilitation.
  • Medicare Advantage计划还涵盖了住院康复，但覆盖范围和费用因计划而异。

从某些伤害，疾病和手术中恢复，可能需要一段时间严格监督的康复。只要您符合某些准则，Medicare就可以在住院康复设施中涵盖您的治疗。

本文讨论的指南涉及住院医学或术后康复，而不是药物使用障碍的住院康复。您可以了解有关Medicare治疗药物使用障碍指南的更多信息here。

Medicare Part A covers只要您的医生认为这是必要的，您在康复设施中的住院护理。此外，您必须在医疗保险批准的设施中获得护理。

Depending on where you receive your inpatient rehab therapy, you may need to have a qualifying 3-day hospital stay before your rehab admission. We’ll discuss that rule in more detail later.

If you’re enrolled in原始Medicare（MedicarePart AandPart B) in 2020, you’ll pay the following costs during each benefit period:

  • Days 1 through 60.You’ll be responsible for a$ 1,364deductible. If you transfer to the rehab facility immediately after your hospital stay and meet your deductible there, you won’t have to pay a second deductible because you’ll still be in a single benefit period. The same is true if you’re admitted to a rehab facility within 60 days of your hospital stay.
  • Days 61 through 90.During this period, you’ll owe a daily coinsurance amount of$341。
  • 第91天及以前。You’ll pay$682coinsurance for each of your终身预备日。You have 60 lifetime reserve days. After you’ve used them all, you’re responsible for all costs.

What is a benefit period?

每个benefit periodbegins the day you’re admitted to a hospital or skilled nursing facility as an inpatient. The period ends 60 consecutive days after your stay without further inpatient care.

If you need to return to the hospital and are admitted within 60 days of your previous stay, you’ll still be in that benefit period. However, if you go back to the hospital after the 60 days without care, a new benefit period begins.

Costs with Medicare Advantage

If you have aMedicare Advantage (Part C)plan, your costs will vary based on your insurer. Talk with your plan advisor or insurance company in advance, if possible, so you can prepare for any out-of-pocket costs.

小费

如果您认为可能需要长期护理，可以探索可用的Medicare AdvantageSpecial Needs Plans。这些计划旨在为患有慢性健康状况的人以及参加Medicare和Medicaid的人提供额外的好处。

Costs with Medigap

AddingMedigap（Medicare补充）coverage could help you pay your coinsurance and deductible costs. Some Medigap plans also offer additional lifetime reserve days (up to 365 extra days).

You can search for plans in your area and compare coverage using Medicare’splan finder tool。

During inpatient rehabilitation, a team of healthcare professionals will work together to help you function on your own again. Your treatment plan will be tailored to your condition but may include:

  • 矫形器或假肢设备的协助
  • 职业治疗
  • 物理疗法
  • psychological services
  • 社会服务

康复可以在医院的特殊部门进行熟练的护理设施，或在单独的康复设施中。

Although Medicare covers your care during rehabilitation, it’s not intended to be long-term care. You can learn more about Medicare and long-term care facilitieshere。

为确保Medicare将涵盖您的住院康复，请遵循以下概述的基本准则。

确保您参加了Medicare

您可以首先在一个名为初始注册期的7个月窗口中注册。这个时期从3个月开始，然后您年满65岁，并在出生月份后3个月结束。

Another opportunity to enroll is during Medicare’s open enrollment period, which is from October 15 to December 7 each year.

If you’re considering a Medicare Advantage (Part C) plan, your enrollment period runs from January 1 through March 31 each year. Depending on your situation, you may also qualify for aspecial enrollment period。

Confirm your initial hospital stay meets the 3-day rule

Medicare covers inpatient rehabilitation care in a skilled nursing facility only after a 3-day inpatient stay at a Medicare-approved hospital.

重要的是，您的医生写命令将您送往医院。如果您在医院过夜进行观察或测试，那将无法计入3天的要求。

These 3 days must be consecutive, and any time you spent in the emergency room before your admission isn’t included in the total number of days. Your discharge day is also not included in the 3-day total.

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It can be hard to know if you’ve been admitted as an inpatient or how long your stay has been. This might leave you unsure whether you qualify for the 3-day rule. This is a helpful guide for determining your inpatient status. You can use this guide when talking with your doctor to get the information you need.

If you’re having surgery, check Medicare’s 2020 “inpatient only” list

Some surgical procedures always require admission as an inpatient. The 3-day rule does not apply for these procedures, and Medicare will cover your inpatient rehabilitation after the surgery. These procedures can be found on Medicare’sinpatient only list。

2018年，Medicare删除了总膝盖更换from the inpatient only list. In 2020, Medicare also removed总髋关节置换from the list. The 3-day rule now applies to both of those procedures.

如果您有Medicare Advantage计划，请与您的保险提供者交谈，以了解您的手术是否被视为仅住院治疗程序。每个计划的覆盖规则都不同，并且知道3天规则是否适用可以为您节省很多钱。

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If you have a Medicare Advantage (Part C) plan, your costs may be higher or lower based on whether your healthcare providers and rehab facility are in network or out of network. Check with your plan before being admitted to a facility to make sure that it’s in network. This will help ensure full coverage and maximum cost savings.

确认你的医生的命令包括required information

为了确保您的住院康复覆盖范围，您的医生将不得不证明您需要：

  • access to a medical doctor 24 hours per day
  • frequent interaction with a doctor during your recovery
  • 访问具有康复服务专业的注册护士
  • therapy for at least 3 hours per day, 5 days per week (although there is some flexibility here)
  • a multidisciplinary team to care for you, including a doctor, rehabilitation nurse, and at least one therapist

如有疑问，请与您的医生交谈或致电Medicare

尽管您并不总是会因突然的疾病或受伤而提前注意，但如果可以的话，最好在手术或住院期间与您的医疗保健团队谈论医疗保险的保险。

如果您想确认自己遵循该信件的医疗保险程序，可以直接致电800-Medicare（800-633-4227或TTY：877-486-2048）与Medicare联系。

Inpatient rehabilitation is goal driven and intense. You and your rehab team will create a coordinated plan for your care. The primary aim will be to help you recover and regain as much functionality as possible.

您的团队将包括专门从事康复护理的注册护士以及一名或多个医生和康复治疗师，具体取决于您的健康状况。您可能还会从心理学家，精神科医生或社会工作者那里获得帮助，他们可以帮助您的心理和情感健康。

You may work with a物理治疗师to:

  • rebuild your strength and ability to move
  • increase your range of motion
  • decrease pain and swelling

你可以使用一个职业治疗师to:

  • 了解如何在恢复过程中使用您需要的任何医疗设备
  • 康复期间进行日常生活的活动
  • prepare for life at home after you’re discharged

You may work with aspeech and language pathologistto:

  • rebuild your vocabulary and practice word retrieval
  • swallow food and drinks
  • 学习新的沟通方式

如果您经历了这些伤害或条件之一，通常需要住院治疗：

Original Medicare and Medicare Advantage plans pay for inpatient rehabilitation if your doctor certifies that you need intensive, specialized care to help you recover from an illness, injury, or surgical procedure.

You might receive inpatient rehabilitative treatment in a dedicated rehab department inside a hospital, at a skilled nursing facility, or at a separate rehabilitation clinic or hospital.

您必须满足某些重要条件，以便Medicare涵盖您的住院康复。即使有Medicare承保范围，您仍然必须支付共同保险和免赔额的费用。

While you’re in rehab, your care will be provided by a team that’ll include nurses, doctors, and therapists. They can help you get back on your feet as quickly and as safely as possible.