Medicare Open Enrollment is an important time for older adults and their families to review healthcare coverage, understand their options, and prepare for the year ahead. But choosing the right Medicare plan involves more than reviewing prescriptions and doctor visits. It’s also important to understand how your coverage may affect future healthcare needs, including rehabilitation after a hospital stay, skilled nursing care, and home health services.
At Nye Health Services, we understand that navigating Medicare can feel overwhelming, especially when you or a loved one is facing a change in health. Knowing what Medicare covers, what it doesn’t, and which questions to ask can help you make more informed decisions.
When is Medicare Open Enrollment for 2027?
During Medicare Open Enrollment, eligible beneficiaries can:
- Switch between Original Medicare and Medicare Advantage.
- Change from one Medicare Advantage plan to another.
- Join, drop, or change Medicare Part D prescription drug coverage.
Changes made during this period generally take effect January 1, 2027. For official information, visit Medicare.gov’s Open Enrollment guide.
Understanding Your Medicare Coverage Options
Medicare offers different coverage options, and understanding the differences can help you choose the one that best meets your healthcare needs.
| Traditional/Original Medicare | Medicare Advantage (Part C) |
|---|---|
| Part A (hospital insurance) and Part B (medical insurance) | Private Medicare-approved plans providing Part A and Part B benefits |
| Generally allows visits to any provider nationwide who accepts Medicare | Often uses provider networks and service areas |
| Can add separate Part D prescription drug coverage | Most plans include prescription drug coverage |
| May purchase Medigap supplemental coverage, subject to eligibility and enrollment rules | Cannot use Medigap to pay Medicare Advantage costs |
| Generally no prior authorization for Traditional/Original Medicare-covered services | Likely requires referrals or prior authorization for certain services |
When comparing plans, consider more than monthly premiums. Review deductibles, copayments, prescription drug coverage, provider networks, and potential rehabilitation or home health needs. Helpful resource: Compare Medicare plans on Medicare.gov.
Does Medicare Cover Short-Term Skilled Rehabilitation?
Yes. Medicare Part A may cover short-term skilled nursing and rehabilitation services when specific eligibility requirements are met. Following a hospitalization, some individuals need additional time and specialized care before safely returning home. Short-term skilled rehabilitation may include physical therapy, occupational therapy, speech therapy, wound care, and skilled nursing services. Under Original Medicare, eligibility generally requires a qualifying three-day inpatient hospital stay, admission to a Medicare-certified skilled nursing facility, and a medical need for daily skilled care. Medicare Advantage plans do not require a qualifying three-day inpatient hospital stay, but generally prior authorization is required.
How much does Traditional/Original Medicare pay for skilled nursing care?
This visual represents traditional/original Medicare plans only. It’s important to understand that 100 days is a maximum benefit limit, not a guarantee of 100 days of covered care. Medicare coverage depends on continued eligibility and medical necessity. For the latest eligibility requirements and costs, visit Medicare’s Skilled Nursing Facility Coverage guide.
Short-Term Rehabilitation at Nye Health Services
At Nye Health Services, our short-term rehabilitation programs focus on helping individuals recover, rebuild strength, and regain independence following an illness, injury, or hospitalization. Our skilled nursing and rehabilitation teams provide personalized support based on each individual’s needs and recovery goals. Learn more about our Skilled Nursing and Rehabilitation Services, including care available at Nye Legacy in Fremont, Nye Pointe in Fremont, Gateway Vista in Lincoln, and Nye Summit in Louisville.
Does Medicare Cover Long-Term Nursing Home Care?
One of the most common misconceptions about Medicare is that it pays for long-term nursing home stays. Medicare generally does not cover long-term custodial care, which includes ongoing assistance with daily activities such as bathing, dressing, eating, and personal care when skilled medical services are not required. Long-term care may be necessary when an individual needs continuous support or supervision beyond a temporary rehabilitation stay.
Short-Term Skilled Care vs. Long-Term Care
| Short-Term Skilled Care | Long-Term Care | |
|---|---|---|
| Primary purpose | Recovery, rehabilitation, or management of a condition requiring skilled services | Ongoing care and assistance |
| Typical duration | Temporary, based on medical need | Extended or ongoing |
| Medicare coverage | May cover qualifying skilled services for a limited period | Generally does not cover custodial care |
| Payment options | Medicare, Medicare Advantage, other insurance, or private pay, depending on coverage | Private pay, qualifying Medicaid benefits, long-term care insurance, or other resources |
Families considering long-term care should begin exploring financial options early. Medicaid may help eligible individuals pay for long-term nursing home services, but eligibility and covered benefits vary by state. At Nye Health Services, we also offer long-term skilled nursing services for individuals who need ongoing medical care and support. Our team can help families better understand the available care options and discuss payment considerations. For more information, visit Medicare.gov: Long-Term Care Coverage
Does Medicare Cover Home Health Care?
Yes. Medicare Part A and/or Part B may cover medically necessary home health services for eligible individuals. Home health care can be an important option for people recovering from illness, managing chronic conditions, or transitioning home after a hospital or rehabilitation stay. Medicare-covered home health services may include:
- Skilled nursing care, such as wound care, medication education, and monitoring of medical conditions.
- Physical therapy to improve strength, balance, and mobility.
- Occupational therapy to support independence with everyday activities.
- Speech therapy to address communication or swallowing difficulties.
- Certain medical social services and part-time home health aide services when eligibility requirements are met.
To qualify, individuals generally must be under the care of a healthcare provider, need qualifying intermittent skilled services, meet Medicare’s homebound criteria, and receive care through a Medicare-certified home health agency.
Under Original Medicare, eligible beneficiaries generally pay $0 for covered home health services, although durable medical equipment may require coinsurance. Medicare generally does not cover around-the-clock care at home or personal care alone when skilled services are not needed.
Continuing Your Recovery at Home with Nye Health Services
Nye Home Health Care helps individuals receive professional healthcare services in the comfort of their own homes. Our team provides skilled nursing, physical therapy, occupational therapy, and speech therapy to support recovery, independence, and quality of life. Whether you’re transitioning home after short-term rehabilitation or need skilled care to manage an ongoing health condition, home health services may help you remain in familiar surroundings while receiving appropriate medical support.
Helpful resource: Medicare.gov: Home Health Services Coverage
How Different Types of Senior Care May Be Covered by Medicare
Does Medicare Cover Outpatient Therapy?
Yes! Medicare Part B covers medically necessary outpatient therapy services, including physical therapy, occupational therapy, and speech-language pathology services. These services can help individuals recover from an injury or surgery, manage chronic conditions, improve mobility, and maintain independence. Unlike short-term skilled rehabilitation, outpatient therapy does not require an inpatient hospital stay. Individuals can receive therapy while living at home or in a senior living community.
How Much Does Medicare Pay for Outpatient Therapy?
Under Original Medicare, beneficiaries generally pay 20% of the Medicare-approved amount for covered outpatient therapy services after meeting their annual Medicare Part B deductible. Medicare Advantage plans must cover medically necessary services covered by Original Medicare, but copayments, provider networks, and authorization requirements may vary. Medicare does not have an annual dollar limit on medically necessary outpatient therapy services, although additional documentation requirements may apply.
Helpful Medicare Resources:
- Medicare Part B – Physical Therapy Coverage
- Medicare Part B – Occupational Therapy Coverage
- Medicare Part B – Speech-Language Pathology Coverage
Five Questions to Ask During Medicare Open Enrollment:
- Are my preferred healthcare providers covered? Check whether your physicians, hospitals, rehabilitation centers, and home health agencies accept your plan and are in-network when required.
- What happens if I need rehabilitation after hospitalization? Review skilled nursing facility coverage, copayments, eligibility requirements, and prior authorization rules.
- Will my plan cover home health services? Understand coverage for nursing and therapy services if you need care at home.
- Have my prescription drug costs changed? Review your current medications, pharmacy network, formulary, and expected out-of-pocket costs.
- What are my total healthcare costs? Compare premiums, deductibles, copayments, coinsurance, and annual out-of-pocket limits where applicable.
Even if you’re satisfied with your current plan, reviewing coverage annually can help you identify changes that may affect your care or expenses.
Where Can I Get Free Help Understanding Medicare?
You don’t have to navigate Medicare enrollment alone. Several reputable resources offer information and assistance.
- Medicare.gov — Official federal Medicare information, coverage details, and plan comparisons.
- Medicare Plan Finder — Compare available Medicare health and prescription drug plans.
- State Health Insurance Assistance Program (SHIP) — Free, unbiased Medicare counseling and assistance.
- Medicaid.gov — Information about Medicaid eligibility and long-term care benefits.
Planning for Your Healthcare Needs with Nye Health Services
Choosing Medicare coverage is an important part of planning for your health, but understanding where to turn when your care needs change is equally valuable. At Nye Health Services, we offer a range of healthcare services designed to support individuals and families through different stages of care, from short-term rehabilitation following hospitalization to ongoing skilled nursing care and home health services. Whether you’re planning ahead or exploring care options for a loved one, our team is here to help you understand the services available and take the next step with confidence. Call us at (402) 753-1400 to speak with a team member!
Explore your care options at Nye Health Services
Disclaimer: Nye Health Services does not provide Medicare insurance enrollment or plan selection services. Medicare eligibility, benefits, and costs vary based on individual circumstances and insurance coverage. Please verify coverage with Medicare or your insurance provider.