Subacute Care and Medicare: What You Need to Know

subacute care medicare

What is subacute care?

Subacute care, or subacute rehabilitation (SAR) is care received inpatient when recovering from an injury or illness. The care is usually received in a skilled nursing facility (SNF). In order to get Medicare coverage, the SNF must be licensed by the Centers for Medicare and Medicaid Services (CMS).

The goal of subacute care is to get you back to functioning at the level you did before entering care. You might still need more therapy or home health care when you are done with SAR.

Examples of issues that might call for subacute care are:

  • Hip replacement
  • Fall
  • Recovering from an illness
  • Heart condition
  • COPD
  • Stroke
  • Diabetes

SAR includes physical, occupational, and speech therapy as well as nursing care. Subacute care usually provides around three hours of therapy in a day, and the stay can last for a few days up to 100 days.

What will Medicare cover?

The following are costs for Medicare Part A in 2021. Subacute care generally falls under Skilled Nursing Facility (SNF) care. Medicare covers up to 100 days of skilled nursing facility care, after which point you’ll have to pay out of pocket. Long-term care insurance may help pay for SNF stay after your coverage period has ended. After you’ve been out of the facility for 60 days, a new coverage period begins and you’ll be covered for 100 more days of care if needed after a three-day qualifying inpatient stay.

Deductible

The Part A deductible for 2021 is $1,484 (up from $1,408 in 2020) and applies to each benefit period rather than a calendar year, but many enrollees have supplemental coverage such as Medigap that pays for this deductible. A benefit period in Part A begins the day you’re admitted into the hospital and ends when you haven’t had any inpatient hospital or skilled nursing facility care for 60 days in a row.

Coinsurance for Hospital Stays

If you need inpatient care, the deductible will cover your first 60 days. After that, you will be charged a daily coinsurance charge of $371 per day from days 61-90. After 90 days, the coinsurance rate is $742 per day. The same cost plan goes for mental health inpatient stays, while you will also pay 20% of the Medicare-approved amount for mental health services while an inpatient. For mental health inpatient stays, there’s no limit to the number of benefit periods you can have, but there is a lifetime limit of 190 days.

Coinsurance for Skilled Nursing Facility Stays

For stays in a skilled nursing facility (SNF), you will pay $0 for days 1-20 each benefit period; $185.50 per day for days 21-100 each benefit period; and all costs for days 101 on.

What you need to know

Research your options before choosing a subacute care facility. You can search Medicare’s Nursing Home Compare tool to find programs with high star ratings. Check to make sure whether your insurance classifies your facility as in-network or out-of-network. Ask around for friends’ personal experiences with subacute care facilities near you. Also, take some time to visit different facilities and pay attention to how the staff takes care of patients there.

Up Next...

blog image

Medicare World Blog

SEE ALL POSTS