(Provided by Aldersgate Retirement Community)
Understanding the rules and regulations around Medicare can be a daunting task.
Just what is Medicare? It is a national social insurance program offered in the United States. First administered by the U.S. federal government in 1966, Medicare uses approximately 30 private insurance companies across the United States. Medicare provides health insurance for Americans aged 65 and older who have paid into the system. It also provides health insurance for younger individuals with disabilities, end-stage renal disease and amyotrophic lateral sclerosis.
When you hear the word, “Medicare,” many confusing terms may come to mind, such as “enrollment,” and “Parts A, B, C and D,” to name a few. There are a few simple things you should know about Medicare and your rights to access it when you are in need.
Hospital stays can often be confusing in terms of how long one must stay in order to access post-hospital rehabilitation. A person must have been admitted to the hospital and stay over three consecutive “midnights” in order to qualify for Medicare Part A coverage. The key word here is “admitted.” Often times today, hospitals will observe a patient without admitting him/her. If one is not officially admitted, the hospital stay may not qualify for Medicare coverage. It is very important for you to understand the difference between being observed and being admitted.
Medicare is there to support you should there be a need for rehabilitation following a hospital admission/stay of three or more “midnights.” Often, a patient is in need of support beyond the hospital but not in one’s home. That support is typically provided by rehabilitation treatment at a Medicare approved facility such as a Skilled Nursing Facility (SNF). This form of rehab can be arranged through social workers between the hospital and the SNF and is covered under Medicare Part A.
Through this coverage, a person can recuperate through services such as physical therapy (PT), occupational therapy (OT) or speech therapy (ST). These forms of therapy can be delivered both on and off-site to support the patient following a hospital stay and support the patient to help bring them back to the level of living prior to their hospital stay.