What Does Medicare Cover?

22- Jul2016
Posted By: Tony Fischer
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What Does Medicare Cover?


Getting Medicare has turned into an aging milestone for most Americans.  For most, getting the government insurance card in the mail means you are officially retired. Every taxpaying citizen of the United States is automatically enrolled in Medicare when they are 65.  In fact you should be getting your care around 3 months before your 65th birthday.

Everyone knows what Medicare is but most still don’t understand what exactly it covers especially when it comes to senior care. This post will give you a brief summary of what types of senior care Medicare covers and for how long.

The Purpose of Medicare

Many assume that because you get Medicare automatically at age 65 that it covers all types of senior care including long-term care. But Medicare was only intended to cover short-term care services like those at the hospital or rehab center. In fact when it comes to long-term care, Medicare’s coverage is very limited and varies based on the type of care being received.

Read Related: How To Pay For Long-Term Care

Medicare is the Default Hospital Coverage for 65 Year Olds and Older

Medicare is the default hospital coverage for folks who are 65 years or older.  The length of stay depends on why the patient was admitted and how they respond to treatment.

Nursing Home Rehab

Today’s nursing homes offer two levels of care.  The level most people are familiar with is long-term care. That is when the patient (referred to as a resident) is expected to stay anywhere from 3 months to multiple years.

Short-term rehab (or Sub-Acute) is they type of care that requires interventions from a physical therapist or registered nursing.  Patients needing short-term rehab may be recovering from an extended hospital stay, stroke, heart failure, Chronic Obstructive Pulmonary Disorder or joint replacement just to name a few.

Doctors often recommend short-term rehab in a nursing home for seniors who cannot keep up with the pace of an inpatient hospital rehab unit.  That is not to say that patients in the nursing home rehab setting aren’t required to show progress.  In fact a patient must show progress and participate in therapy in order to keep their Medicare coverage.

Coverage can last up to 100 days if progress is being shown but even then Medicare doesn’t cover the entire bill.  Medicare covers 100% of a nursing home rehab stay for only 20 days.  If the stay lasts beyond 20 days, Medicare covers roughly 80% with the remaining 20% being covered by a Medi-Gap insurance or coming out of the patient’s pocket.

Home Care

When the senior is ready to discharge from the hospital or nursing home rehab; home care may be prescribed by the doctor.  Home Care is approved in 60-day increments and is typically covered 100% by Medicare. However like short-term rehab coverage the patient must show progress in therapy treatments.

Read Related: Home Care: How It Works.

Outpatient Rehab

If the patient doesn’t require a skilled nursing environment like that of a nursing home or meet the home bound criteria for Home Care, outpatient rehab may be needed.  Medicare covers outpatient therapy but co-payments may be needed depending on the type of diagnosis and length of care.  Check with the outpatient rehab clinic for coverage details.

More Questions?  Senior Care Sherpa Can Help

We are here to help.  Our Senior Care Sherpa’s are experts in senior care and can help you develop a senior care plan.  CLICK HERE for more information about how one of experts can help you.


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Tony Fischer

<p>As an advocate for elders and their families, Tony has experience in the entire healthcare continuum. He has worked in hospitals, nursing homes, home care, hospice, and non-profits. </p>
<p>His vast and unique experience led him to become a consultant that helps clients navigate the senior healthcare system. Tony also works hand and hand with healthcare providers to improve and streamline customer service.</p>