If you or your loved one is need of skilled nursing or rehabilitation services, one of your concerns will be payment. Knowing ahead of time what is and isn’t covered under your Medicare plan will go a long way in easing your mind, as well as preparing you in the event you need to pay out-of-pocket.

Medicare typically covers the following:

• Semi-private rooms (if you share with one or more residents)
• Dining
• Skilled nursing care
• Physical and occupational therapy
• Speech and language services
• Medical social services
• Medication
• Medical supplies and equipment used in our facility
• Ambulance transportation, if needed
• Dietary counseling

However, with physical/occupational therapy and medications, the language in Medicare documents states that services will be covered only if they are deemed to be “medically necessary.”

Therapy

There are caps to the amount Medicare will pay out for therapy. For example, in 2014, the physical and occupational therapy caps at $1,920. Beyond that amount, your provider must provide documentation that explains the medical necessity of continued treatment.

Medications

Like outpatient therapies, Medicare Part B covers certain prescription drugs, but not those you would give to yourself. Drugs that aren’t covered by Part B may be covered under Part D, which is a separate prescription drug plan through Medicare. (Get more information on this here.)

Drugs covered under Part B include (but are not limited to) the following:

• Nebulizers, or infusion pump
• Injectable osteoporosis drugs
• Blood-clotting medications
• Intravenous/tube feeding
• Vaccinations such as flu shots, Hepatitis B, and pneumonococcal
• Immunosuppressive drugs (used after a major organ transplant)

Medicare is specific about what it will and will not cover, so it’s a good idea to have done some research before undergoing physical, occupational or drug therapy. Talk to your provider, view the Medicare website for details, and ask an Embassy professional what may or may not be covered. Our goal is to make your time at Embassy Healthcare as smooth and healing as possible.

Contact us to receive more information on payment options, or Medicare plan details.