Encompass Health is one of the leading providers of postacute healthcare services in the United States. It specializes in inpatient rehabilitation, home health care, and hospice care. Its rehabilitation hospitals are particularly wellknown for helping patients recover after surgeries, injuries, and other medical conditions that require intensive therapy. If you’re considering Encompass Health for a loved one or for yourself, a key question that may come up is whether Encompass Health takes Medicare. This article will address that question, explore how Medicare works with Encompass Health, and guide you through the specifics of Medicare coverage at Encompass Health.
Overview of Medicare
Medicare is a federal health insurance program primarily designed for people aged 65 and older, though it also serves younger individuals with disabilities or specific medical conditions, such as endstage renal disease (ESRD). Medicare consists of different parts, each covering a specific aspect of healthcare:
Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.
Medicare Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and some home health care services.
Medicare Part C (Medicare Advantage): Offers an alternative to Original Medicare (Part A and Part B) through private health insurance plans that must cover everything Original Medicare covers and may provide additional benefits.
Medicare Part D (Prescription Drug Coverage): Provides coverage for prescription medications.
Understanding the parts of Medicare is important because different types of healthcare services are covered under different parts, and this affects whether Encompass Health can accept Medicare as payment.
Does Encompass Health Take Medicare?
The short answer is yes,Encompass Health accepts Medicare for both inpatient rehabilitation and home health services, as long as the patient meets the specific requirements of Medicare coverage. Encompass Health operates both inpatient rehabilitation hospitals and home health care services across the country, and both types of care are commonly covered by Medicare.
Medicare and Inpatient Rehabilitation
One of Encompass Health’s core services is inpatient rehabilitation, which is provided in specialized hospitals designed to help patients recover after major surgeries, strokes, spinal cord injuries, joint replacements, or severe illnesses that require intensive rehabilitation therapy. Inpatient rehabilitation is essential for patients who need skilled care and daily therapy to regain functional independence.
Medicare Part A covers inpatient rehabilitation under certain conditions, including:
The patient must require rehabilitation therapy and be admitted to a Medicarecertified inpatient rehabilitation hospital.
The patient must be able to participate in and benefit from intensive therapy, which typically means receiving at least three hours of therapy per day, five days a week.
The patient must have a qualifying medical condition such as a stroke, traumatic brain injury, spinal cord injury, or joint replacement surgery.
In the case of Encompass Health, most of their inpatient rehabilitation hospitals are Medicarecertified, which means that they accept Medicare for eligible patients. Medicare typically covers 100% of the cost of inpatient rehabilitation for the first 20 days, as long as the patient meets the necessary criteria. After the first 20 days, patients are required to pay a daily coinsurance amount for the remaining days of their stay, up to 100 days in total. For the remaining days, the patient may also be responsible for copayments, depending on the specific circumstances.
Medicare and Home Health Care
Encompass Health also provides home health care services, which are especially beneficial for individuals who need medical assistance but do not require hospitalization. Medicare Part A and Part B cover home health services if the patient qualifies, and the services are provided by a Medicarecertified home health agency like Encompass Health.
Home health care services provided by Encompass Health can include:
Skilled nursing care
Physical, occupational, and speech therapy
Home health aide services
Medical social services
Durable medical equipment (DME)
To qualify for home health care services under Medicare, the patient must meet the following conditions:
1.Homebound Status: The patient must be considered homebound, meaning they have difficulty leaving their home without assistance or experiencing an exacerbation of their condition.
2.Need for Skilled Care: The patient must require skilled nursing care or therapy, as prescribed by a doctor. The care must be provided on a shortterm basis, not as longterm support.
3.Doctor’s Certification: A doctor must certify that the patient needs home health care services, and the care must be ordered by a physician as part of a plan of care.
Medicare Part A and Part B will generally cover home health services provided by Encompass Health if the patient meets these eligibility requirements. Medicare typically covers 100% of the costs of eligible home health care services, with the exception of durable medical equipment (DME), which may involve additional outofpocket costs depending on the patient’s specific Medicare plan.
Medicare Advantage (Part C) and Encompass Health
Medicare Advantage, or Medicare Part C, is a private health insurance plan that provides an alternative to Original Medicare (Part A and Part B). Medicare Advantage plans must cover all the services that Original Medicare covers, including inpatient rehabilitation and home health care. However, Medicare Advantage plans often offer additional benefits, such as prescription drug coverage, vision, dental, and wellness programs.
If a patient has a Medicare Advantage plan, Encompass Health may still be covered under the plan, but there are some important things to consider:
1.Network: Some Medicare Advantage plans require patients to receive care from providers within a specific network of doctors, hospitals, and health care facilities. If Encompass Health is innetwork for the patient’s plan, they will likely be covered. If it is outofnetwork, the patient may face higher outofpocket costs.
PlanSpecific Coverage: Although Medicare Advantage plans must cover the same services as Original Medicare, the plan may have additional restrictions, such as preauthorization requirements or limits on the amount of therapy covered. It’s important for patients to review the details of their Medicare Advantage plan and verify with Encompass Health if the services they need will be covered.
Billing and Payment for Medicare Patients at Encompass Health
When patients receive care at an Encompass Health facility, the process of billing and payment can vary depending on their Medicare coverage. Here is an overview of how billing typically works:
Inpatient Rehabilitation Billing
For inpatient rehabilitation, Medicare will generally cover the cost of care for patients who meet the eligibility requirements. The billing process follows these guidelines:
Part A Coverage: If the patient is admitted to an inpatient rehabilitation hospital, Medicare Part A will typically cover the cost of hospitalization. This includes room and board, medical services, and therapy.
2.Coinsurance: After the first 20 days, patients will be required to pay a daily coinsurance amount. For days 21 to 100, Medicare pays a large portion, but patients may still be responsible for a portion of the cost.
3.OutofPocket Costs: For stays longer than 100 days, the patient is responsible for the full cost of care. Patients may also need to pay for noncovered services or additional therapies that exceed Medicare limits.
Home Health Care Billing
For home health care, Medicare will generally cover the cost of care as long as the patient meets the eligibility criteria. The billing process for home health care is as follows:
Medicare Part A or B Coverage: Medicare covers home health services under both Part A and Part B, depending on whether the patient is already enrolled in Part A or receiving outpatient care under Part B.
2.No Copayments for Services: For most covered home health services, Medicare pays 100% of the costs, including nursing, therapy, and medical equipment. However, the patient may be responsible for copayments for certain services, such as durable medical equipment.
3.Eligibility Verification: Encompass Health will verify the patient’s Medicare eligibility and determine the exact coverage for home health services.
Conclusion
Yes,Encompass Health accepts Medicare, and the company offers a variety of services that are eligible for Medicare coverage. Whether you’re seeking inpatient rehabilitation or home health care services, Encompass Health’s Medicarecertified facilities can help meet your healthcare needs. Patients must meet certain eligibility criteria for Medicare to cover these services, but for those who qualify, the majority of care is typically covered, with some outofpocket expenses depending on the specifics of the Medicare plan.
If you’re considering Encompass Health for a loved one or yourself, it’s important to confirm with both your Medicare plan and Encompass Health to understand the exact coverage and costs involved. With its reputation for highquality care and its acceptance of Medicare, Encompass Health remains a trusted choice for postacute healthcare services.
