Medicare Information and FAQs

If you have questions about Medicare coverage for skilled nursing or rehabilitation care, contact the admissions department of Koester Pavilion or SpringMeade Health Center.

Our admissions departments can also advise you on managed care contracts at Koester Pavilion or SpringMeade Health Center.

Medicare Frequently Asked Questions

When does Medicare cover care in a skilled nursing facility (SNF) such as Koester Pavilion or SpringMeade Health Center?

For a limited time, under certain conditions, Medicare Part A (hospital insurance) covers skilled nursing care provided in an SNF. Coverage includes:

  • Skilled nursing care
  • Physical, occupational and speech therapy, if needed to meet health goal
  • Medical social services
  • Semi-private room (shared room)
  • Meals
  • Medications
  • Medical supplies and equipment used in the SNF
  • Ambulance transportation (when other transportation endangers health) to the nearest provider of needed services not available at the SNF
  • Dietary counseling

What physical, occupational and speech therapy services are covered by Medicare?

Medicare Part B (medical insurance) helps pay for medically necessary outpatient physical and occupational therapy, and speech-language pathology services. In 2018, limits were eliminated on how much Medicare pays for therapy services in one calendar year.

However, if your therapy claims reach certain amounts set by Medicare, your therapy provider will need to add notations to your therapy claims and medical record to indicated that the therapy is reasonable and necessary and why the services are needed.

Your therapy provider must provide you an Advance Beneficiary Notice of Noncoverage when offering services that are not medically necessary. This allows you to decide whether you want the services, which you will be responsible for paying.

In what cases are prescription drugs covered by Medicare?

Drugs covered under Part B are generally those you don’t give yourself – such as medications you get at a doctor's office or health care facility. Medicare Part B generally doesn't cover prescription drugs that you use at home. But under limited conditions, it covers some outpatient prescription drugs.

Drugs not covered under Part B may be covered under Part D Medicare prescription drug coverage.

When does Medicare cover ambulance services?

Medicare Part B covers ambulance services to or from a hospital or skilled nursing facility. Medicare covers and helps pay for ambulance services only when other transportation could endanger your health due to your medical condition. This coverage applies only to ambulance transportation to the nearest medical facility that’s able to provide the care you need.

Medicare Part B also covers:

  • Emergency ambulance transportation when you have a sudden medical emergency and you can’t be safely transported by other means, such as car or taxi
  • Emergency ambulance transportation in an airplane or helicopter if your health condition requires immediate and rapid transport
  • Non-emergency ambulance transportation if your doctor provides a written order that ambulance transportation is medically necessary

What nutrition therapy services are covered by Medicare?

Medicare Part B covers medical nutrition therapy services and certain related services ordered by your doctor. A registered dietitian or nutrition professional who meets certain requirements can provide these services, such as:

  • Initial nutrition and lifestyle assessment
  • Individual and/or group nutrition therapy services
  • Follow-up visits to check on progress in managing your diet

Under Part B you’re eligible for this coverage, with doctor referral, if you meet at least one of these conditions:

  • Have diabetes
  • Have kidney disease
  • Have had a kidney transplant in the last 36 months

Can you return to a skilled nursing facility if you must be readmitted to a hospital?

There’s no guarantee that a SNF bed will be available when you’re discharged from the hospital, if you need more skilled nursing care after your hospital stay. In such a case, talk with admissions at Koester Pavilion or SpringMeade Health Center about holding a bed for you.

To qualify for this, you must meet certain requirements under Medicare Part A. For instance, have days left in your benefit period, have a qualifying hospital stay, and your doctor determines that you need daily skilled care – among other requirements.

For more information on coverage, visit Medicare.gov, or contact the admissions department of Koester Pavilion at (937) 440-5103(937) 440-5103 or SpringMeade Health Center at (937) 506-2707(937) 506-2707.

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