By Indy Senior Advisor Care Team · August 31, 2026
Medicare Open Enrollment runs October 15 to December 7. The plan your parent picks decides whether a rehab stay after a fall is covered, for how long, and which Indianapolis facilities are even available.
Nobody enrolls in a Medicare plan thinking about a broken hip
Every October, a stack of glossy plan comparisons lands on your parent's kitchen table in Fishers or Beech Grove. Most people skim the dental benefit, check whether their cardiologist is still in network, and re-enroll in whatever they had. That is a reasonable way to spend twenty minutes.
It is also the decision that will govern what happens if they fall in February. Nearly every family we work with in the Indianapolis metro arrives at senior care through a hospital, not through a plan. Somebody breaks a hip, spends a few days at Methodist or Community North, and gets sent to a skilled nursing facility for rehab. That rehab stay is where families first collide with what their Medicare coverage actually says.
The gap between what people assume Medicare covers and what it covers is wide. Open Enrollment, which runs October 15 through December 7 each year with changes effective January 1, is the only routine window most people get to do anything about it. It is worth more than twenty minutes.
What Original Medicare actually pays for a rehab stay
Under Original Medicare (Part A and Part B, usually with a supplement), skilled nursing facility care after a hospitalization is covered on a sliding scale within a benefit period. Days 1 through 20 cost the beneficiary nothing. Days 21 through 100 carry a daily coinsurance, which CMS set at $217.00 per day for 2026, up from $209.50 in 2025. After day 100, Medicare pays nothing toward that stay.
Do the arithmetic families rarely do in advance: if a stay runs the full 100 days, the coinsurance on days 21 through 100 comes to $17,360 out of pocket. Most Medicare supplement (Medigap) plans cover that coinsurance, but not all of them do — Plans A and B, the two leanest letters, do not. If your parent has been quietly paying for the cheapest supplement for a decade, that is a number worth knowing before the ambulance shows up.
There is a second condition, and it is the one that trips people. Original Medicare only covers skilled nursing care after a qualifying hospital stay of at least three consecutive days as an admitted inpatient. The admission day counts. The discharge day does not. Time in the emergency department does not.
And the widely repeated line about "up to 100 days" misleads people in a specific way. It is a ceiling, not an entitlement. Coverage continues only as long as your parent needs daily skilled care. Plenty of Indianapolis-area rehab stays end at day 14 or day 22 because the facility determines skilled care is no longer needed, and that determination is what ends the coverage, not the calendar.
Observation status is where central Indiana families get caught
Here is the trap. A patient can spend three nights in a hospital bed at IU Health North or Franciscan Health Indianapolis, be examined by physicians, receive medication and imaging, and never once be an inpatient. They were in observation status, which Medicare classifies as outpatient care. Those nights do not count toward the three-day inpatient requirement.
Federal law requires the hospital to hand a patient in observation for more than 24 hours a form called the Medicare Outpatient Observation Notice, or MOON. CMS issued an updated version of that notice effective April 21, 2026, in use through February 2029. The Center for Medicare Advocacy, which has tracked this issue for years, points out that the redesigned notice is easier to read but drops the specific warning that Part A will not cover a skilled nursing stay without three consecutive inpatient days. It now says only that Medicare "may not pay" if you go to a skilled nursing facility.
So the form your family gets may not tell you the thing you most need to know. Ask directly, in plain words, at the nurses' station or of the case manager: "Is my mother admitted as an inpatient, or is she under observation?" Ask on day one. Ask again on day two. If the answer is observation and a rehab stay looks likely, ask the attending physician whether an inpatient admission is clinically appropriate. That conversation has to happen while your parent is still in the hospital. It cannot be fixed afterward.
We wrote separately about how discharge planning works at the major Indianapolis health systems, and about what to do when the discharge clock is already running.
Medicare Advantage changes the math in both directions
Roughly half of Medicare beneficiaries nationally are now in Medicare Advantage plans, and the Indianapolis market is heavily marketed. Advantage plans are not a worse choice or a better one in the abstract. They trade differently, and the trade shows up precisely at the rehab stage.
On the favorable side, many Advantage plans have CMS approval to waive the three-day inpatient requirement. A member can sometimes go straight from home or from a short hospital stay into a skilled nursing facility with coverage intact. That is a real advantage over Original Medicare, and it removes the observation-status trap described above.
On the other side, Advantage plans substitute a different gate: prior authorization. Nearly all of them require the plan to approve a skilled nursing admission before it is covered, and plans apply their own utilization management review to decide when skilled care is no longer necessary. Families in this position often describe rehab ending sooner than they expected, by a decision made by a reviewer who has never seen the patient.
There is also a network question that matters enormously in a metro this size. Original Medicare is accepted by essentially any Medicare-certified facility. An Advantage plan has a network, and the skilled nursing facility ten minutes from your house in Zionsville may or may not be in it. When the hospital case manager hands you a list of available beds, the plan is what narrows that list. If there is a particular rehab facility your family already knows and trusts, check whether it is in-network before December 7, not after the fall.
The free, unbiased phone call to make before December 7
Indiana runs a State Health Insurance Assistance Program — SHIP — through the Indiana Department of Insurance. It is free, it is staffed by trained and certified counselors, and it does not sell insurance. The central office line is (800) 452-4800.
Locally, CICOA Aging & In-Home Solutions, the Area Agency on Aging serving Marion, Hamilton, Hendricks, Johnson, Boone and Hancock counties, employs SHIP-certified counselors and takes appointments in person, by phone or virtually. Their Resource Center number is (317) 803-6131, weekdays 8 a.m. to 5 p.m., and CICOA states plainly that it is not affiliated with any insurance company or agency and does not sell insurance. That distinction is worth a great deal when the alternative is a television commercial or a mailer from a licensed agent who is paid a commission on what your parent picks.
The same counselors can screen your parent for the Medicare Savings Program and for Extra Help with drug costs, which are separate from plan selection and which a surprising number of eligible Hoosiers never apply for. We covered what one call to CICOA's Resource Center actually gets you in more detail.
Come to that call with a specific question, not a general one. "Which plan is best?" produces a shrug. "My father has congestive heart failure, uses these four drugs, and if he needs rehab we want him at a facility on the northeast side — what should I be comparing?" produces something useful.
Switching back is not the mirror image of switching in
This is the part of Open Enrollment that gets described inaccurately more than any other. Moving from Original Medicare into a Medicare Advantage plan is easy. Moving back out is easy in one direction only: you can return to Original Medicare during Open Enrollment without anyone's permission.
What is not guaranteed is the Medigap supplement that makes Original Medicare affordable. Outside of specific protected windows, a Medigap insurer in Indiana may medically underwrite your application — meaning it can ask health questions, and it can decline. Somebody who has developed a serious condition while enrolled in an Advantage plan may find they can go back to Original Medicare but cannot buy the supplement that would cover that $217-a-day coinsurance.
There are protections. The best known is the trial right: someone who joined a Medicare Advantage plan when first eligible for Medicare, and who leaves within twelve months, generally has a guaranteed-issue right to buy a supplement. Indiana also enacted a Medicare supplement "birthday rule" that took effect in 2026, creating an annual window around a policyholder's birthday to switch supplements without underwriting.
We are not going to print a specific number of days for that birthday window, because the statute was amended partway through 2026 and the secondary sources describing it do not agree with each other on the exact length or start date. Ask SHIP. This is exactly the kind of question a free, non-commissioned counselor should answer, and exactly the kind of question you should not take from a sales call.
When the rehab benefit ends, the long-term bill begins
The hardest conversation in this whole sequence usually happens around week three. Medicare's skilled nursing benefit is rehabilitation coverage. It is not long-term care coverage, and it was never designed to be. When the therapy goals are met, or when the plan or facility determines skilled care is no longer needed, coverage stops — and if your parent still cannot safely go home, the family is now paying privately, in a system with an entirely different set of rules.
At that point Indiana's own framework takes over: assisted-living-type communities licensed as Residential Care Facilities under 410 IAC 16.2-5, the PathWays Waiver and the separate RCAP room-and-board program for those who qualify for Medicaid, or private pay. The 2025 CareScout Cost of Care Survey puts Indiana's statewide median at $5,639 a month for a one-bedroom in assisted living and $8,943 a month for a semi-private nursing home room. Those are state medians. No primary source publishes an Indianapolis-specific figure, and anyone quoting you one for Marion County is estimating.
Nothing about Open Enrollment changes that second bill. But understanding the boundary — that Medicare pays for recovery and Indiana's programs and your parent's savings pay for the rest — is what keeps the week-three conversation from arriving as a shock. See short-term rehab versus long-term nursing care and how families actually pay for care.
If coverage ends and you think it is too soon, you can appeal fast
Before a skilled nursing facility stops billing Medicare, it must give the resident a Notice of Medicare Non-Coverage, generally at least two days before services end. That notice is not a verdict. It carries an appeal right, and the appeal is genuinely fast — decided in a matter of days, not months, and free.
The appeal goes to the Beneficiary and Family Centered Care Quality Improvement Organization for your region. Indiana sits in Region 5, along with Ohio, Illinois, Michigan, Minnesota and Wisconsin. The number is 1-888-524-9900. Call it by the deadline printed on the notice; missing that deadline is the most common reason families lose an appeal they might have won.
One more thing worth knowing, because it is widely misunderstood by families and sometimes by staff: Medicare covers skilled care needed to maintain a patient's condition or slow decline, not only care that produces measurable improvement. "He's plateaued" is not, by itself, a lawful basis for ending coverage. If that is the reason you are given, say so on the appeal call.
If the underlying question is not about coverage but about how your parent is being treated, that is a different channel entirely — the long-term care ombudsman, or in Indiana a licensing complaint to the state health department. We laid out which office handles which problem separately.
