My mother will be undergoing hip replacement surgery at a hospital in Saginaw, Michigan in late June. Her surgeon has advised us that she will likely need to go to a rehab center for a few weeks of therapy after she leaves the hospital. We are trying to figure out if Medicare will pay for that and how to choose the best one for her recovery. Can you help us understand what this means?
Diane in Adrian, Michigan
It is a definitely a good idea to tackle all of this before your mother’s surgery. That will help her make a smooth transition to the skilled nursing and rehab center and then, eventually, back home.
Here is how the Medicare Skilled Nursing & Rehab Benefit works:
- Your mother will qualify for the benefit if she spends three nights at an inpatient level of care in the hospital.
- Once she transitions to the skilled rehab center, Medicare will pay for the first 20 days in full.
- Beginning on the 21st day, she will be liable for a co-payment amount. In 2014, that is $152 per day. If she has a secondary insurance, it may cover this amount.
- If she still isn’t back on her feet after day 100, she will be liable for the entire cost of the stay. But don’t worry. Most seniors are back on their feet and home long before this!
As far as finding the best provider, Medicare has a few tools that can help. One is the Nursing Home Compare rating system on Medicare.gov. It allows you to review each provider’s state survey results and (if applicable) complaint surveys from residents and their family members. Medicare also has a Skilled Nursing Facility Checklist you can download to help you compare one community with another.
Finally, our best piece of advice is to tour every community you are considering for your mother. It would probably be a good idea to have a list of 2 or 3 options. That way if one or two of them are full, you still have another option that your family has already visited and approved of to turn to for rehab.
I hope this helps, Diane! Best of luck to your mother in her surgery and rehab.
The Medicare Wellness visit is one of the many benefits the Affordable Care Act (ACA) brought to seniors. Despite being launched in January of 2011, however, many primary care physicians and their patients are still not utilizing the benefit. For physicians, the visit provides them with an opportunity to develop a preventative plan for each patient on an individual basis. There is financial incentive for physicians to be sure their Medicare patients schedule the wellness visit – it pays nearly three times the rate of a typical Medicare patient visit.
So why are many seniors still not taking advantage of the benefit? Most are simply unaware of it and what it entails.
The Medicare Wellness Visit
The once-a-year benefit is a wellness visit provided at no cost to seniors. The focus of it is to develop or update prevention plans and evaluate chronic health conditions, such as diabetes or asthma. The physician will talk with the patient about their health, lifestyle and overall fitness regime. In addition, the physician will likely:
- Measure height, weight, and body mass index
- Check blood pressure
- Perform a simple vision test
- Evaluate cognitive function
- Assess the patient for their risk of depression
- Other routine testing based on patient and family medical history
- Refer patient for further testing or evaluation by specialists if necessary
Based on their discussion with the patient and the results of the physical examination, the primary care physician will develop a personalized preventative care plan that includes timelines for health screenings. They will also make recommendations for any lifestyle improvements they believe will contribute to the patient’s overall health and wellness. It might be nutrition counseling, a smoking cessation program or suggested physical activities.
Medicare Welcome Visit versus Wellness Visit
There is some confusion among patients because Medicare also allows a one-time Medicare Welcome Visit. This appointment is for new Medicare recipients. It must take place within the first year of receiving Medicare Part B benefits.
Medicare Part B Wellness Visit Costs
Because one of the goals of the Affordable Care Act is to reduce health care expenses by focusing more on prevention, there is no cost to Medicare Part B recipients. Patients are entitled to one wellness visit every 11 months. One important thing to note is that while the visit is at no cost to patients, any recommendation testing or follow-up may not be.
If you are the caregiver for an older adult in Michigan, be sure to speak with their physician about scheduling an appointment to take advantage of this benefit.