Medical insurance is difficult to understand, and when you are trying to care for a critically, chronically ill loved one, you don’t need any additional complications like trying to figure out if their care is covered. Fortunately, Medicare has clear guidelines about the type of transitional care that is provided in long-term acute care hospitals like Kindred Hospitals.

Transitional care hospitals provide intensive care to help people recover and begin rehabilitation after surgery, injury or serious illness over the course of several weeks. Medicare acknowledges the benefits this level of care provides for people who have recently spent three or more days in an intensive care unit (ICU) or who have used a ventilator to support their breathing and need help learning to breathe independently again.

Your Guide to Medicare and Transitional Care 600

Medicare is the nation’s largest insurance program, covering people over the age of 65, or those under 65 who have been totally and permanently disabled for at least 10 years. 

A plan in two parts

Medicare is made up of two sections. Part A, which is usually available at no cost to you, helps pay for inpatient hospital care as well as hospice. Part B, which usually requires a monthly premium, helps pay for doctor’s services, outpatient hospital care, some medical services and some home healthcare.

Part A at a glance:

  • You are eligible for Part A when you turn 65 if you or your spouse has paid in during enough quarters of the year.
  • If you did not pay Medicare taxes, you may be able to buy Part A.

Part B at a glance:

  • You can purchase Part B when you turn 65.
  • You or another payer, such as Medicaid, pay a monthly premium.
  • Part B also includes some hospice provisions.
  • Part B covers outpatient hospital visits and some medical services that Part A does not.

What hospital services does Medicare cover?

Medicare Part A (hospital insurance) covers care in a long-term acute care hospital when a person has more than one serious condition or their condition may improve with the appropriate amount of time and care in this setting. This coverage includes:  

  • Inpatient hospital services, medications and supplies
  • Nursing care
  • Rehabilitation services
  • Pain management
  • Semi-private room
  • Meals

Medicare coverage is tied to a benefit period, which begins on the day you are admitted to a hospital, emergency room or intensive care unit, and ends when you have been out of the hospital for 60 days in a row. You will not pay a new deductible if you are transferred to a transitional care hospital.

Once you meet 60 days after a hospital stay, if you return to the hospital, it is a new benefit period. Medicare will pay for your stay up to 60 days, but on days 61 through 90, you will pay coinsurance. Check with your policy on coverage if a stay exceeds 90 days.

What doesn’t Medicare cover?

Medicare will not cover services they have previously outlined, such as:

  • Convenience items like razors
  • Custodial care
  • Private-duty nursing care
  • A private room
  • Inpatient days beyond the Medicare Part A maximum number of days in a benefit period

What would I need to pay?

You may be responsible for paying a portion of inpatient care that is not covered by Medicare Part A. These can include:

  • Your deductible. Check with Medicare to determine what your deductible is for a given year.
  • Coinsurance. This is the part of Medicare-approved costs for transitional hospital care that you may need to pay after you’ve met your deductible.

For more information, call Medicare toll-free at 1.800.638.6833.

If you have questions about transitional care services, call 1.866.KINDRED to speak with a Registered Nurse 24 hours a day, seven days a week. Our nurses can help determine if this type of care is right for you or your loved one, and if your health plan covers it. 

By Mel Bearns