Yesterday my MIL went in for total knee replacement surgery. We knew a couple of years ago that this would have to happen eventually, and our plan was always to decide what year we were going to have the surgery done and transfer her to an MA plan that had better rehab benefits than her current one.

That’s all well and good, but sometimes, plans mean nothing. When it came up, it didn’t make sense for her health to wait until a new benefit year. Luckily, we had built up a very nice savings balance for her with the intent of using it to pay her portion of medical bills.

Still, if you think you might need surgery in the next year or two, that’s something you need to pay attention to when choosing an MA plan.

Co-pays for hospital stays and skilled nursing facilities are usually listed right up front. I’ve seen hospital stays at $100/day for the first 5 days, $0 every day after and also at $350/day for the first 3 days. $0 every day after. The first one is cheaper, so make sure you do the math, not just count the number of days.

Skilled nursing facility co-pays work very much the same way.

It is important to note that Medicare (and therefore MA plans) will only pay for skilled care, not custodial care. What this means is that they only pay if the patient needs daily rehab or nursing care. They do not pay if the patient needs someone to help them go to the restroom or get dressed, even if the difficulty is the result of Medicare covered surgery.

But while the hospital and SNF co-pays are generally listed high up on the benefit information, rehab co-pays are buried at the bottom. (There does appear to be a standard order that benefits are listed in, so this cannot necessarily be blamed on the insurance companies.) I have found that the biggest discrepancies in similarly priced plans always seem to come from the costs of rehabilitation appointments- and not just physical therapy for orthopedic surgeries like total knee or hip replacements, but also cardio-pulmonary rehab- so the appointments you need to make after having heart surgery.

Make sure you scan all the way to the bottom of the listed co-pays to make sure you are comparing not just the hospital and SNF costs but also the costs of rehab appointments. It can easily swing the balance as to what plan is the best for you.

Again, always do the math.

This is also a good time to mention that you need to double check your out of pocket maximum (again, listed at the top of the benefit list) and find out if co-pays count toward that max.

I recently helped someone decide if a PPO MA plan was right for them. It had a really high out of pocket max, compared to similarly priced plans, that concerned me. However, that plan stated that co-pays and co-insurance counted toward the OOP max. In the cases of the other plans, the ones with lower OOP maximums, only co-insurance payments counted toward the max. That also changes the math.

Hint: A co-pay lists a specific amount that you are required to pay, regardless of cost. Co-insurance is always listed as a percentage of the fee charged.