Patricia Barry - Medicare For Dummies

TABLE 2-1Preventive Care Services Medicare Covers

Source: Centers for Medicare & Medicaid Services

Note:Services labeled “free” (meaning no co-pay or deductible required) assume that you go to a doctor who accepts Medicare’s payment in full.

Medicare Part A is usually associated with care within the hospital, of course. But it also covers certain specialized services outside the hospital, most of which focus on nursing. Part B, too, covers some types of specialized care, such as physical therapy. The following sections provide a quick overview.

Say you’ve been in the hospital and are being discharged but still need more-specialized nursing care than you can receive at home — physical therapy to help you walk again after a hip replacement, speech therapy after a stroke, a continuing need for intravenous fluids, or wound care. Medicare covers this type of ongoing care under Part A, usually at what’s called a skilled nursing facility — most often a nursing home — under certain conditions.

The most important condition for Medicare coverage of care in a skilled nursing facility is that you must have been in the hospital as a formally admitted patient for at least three days. (This three-day rule conceals a hidden pitfall — situations where the hospital places you under “observation” — that you really need to know about; see Chapter 14.) A doctor must order the services that you need from professionals such as registered nurses and qualified physical therapists and speech or hearing pathologists. And the skilled nursing facility you go to must be one that Medicare has approved.

Traditional Medicare covers stays in a skilled nursing facility for up to 100 days in a benefit period. The first 20 days cost you nothing; from day 21 through day 100, you pay a daily co-pay, which goes up slightly every year (in 2020, $176 a day). Some Medigap supplemental insurance policies cover these co-pays 100 percent. (Head to Chapter 4for details about Medigap insurance.) If you’re enrolled in a Medicare Advantage health plan, look at your coverage documents or call your plan to find out what it charges for stays in skilled nursing facilities.

For more information, check out the official publication “Medicare Coverage of Skilled Nursing Facility Care” at www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf .

These services provide some of the same types of care that you may get in a skilled nursing facility but bring them to you in your own home. They include

Skilled nursing care provided on a part-time basis (no more than eight hours a day over a period of 21 days or less) and including services such as injections, feeding through a tube, and changing catheters and wound dressings.

Physical, speech, and occupational therapy from professional therapists to help you walk again, overcome problems in talking, or regain the ability to perform everyday tasks, such as feeding and dressing yourself — whichever your medical condition requires.