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Obamacare's 10 essential benefits: Meet the rehab team

About 1 in 5 adults in the United States has a disability -- most commonly arthritis, back problems and heart conditions, according to the U.S. Centers for Disease Control (CDC). These disabilities can make it difficult for people to perform activities such as walking or climbing stairs.

The Affordable Care Act (ACA), also known as Obamacare, was passed by Congress and signed into law in 2010.   Under the ACA, patients now have access to 10 essential health benefits like prescription drugs, mental health services, and wellness visits.  

Coverage for rehabilitative and habilitative services is also included as one of the 10 essential benefits.  Medical devices like walkers and canes are covered under rehabilitative and habilitative services.         

obamacare essential benefit rehab What are rehab services?

Rehabilitative services are defined by as "health care services that help you keep, get back, or improve skills and functioning for daily living that have been lost or impaired because you were sick, hurt, or disabled."

Habilitative services are defined as "health care services that help you keep, learn, or improve skills and functioning for daily living."

Rehabilitation services may include speech therapy for an adult recovering from a stroke, while habilitation services may include speech therapy for a child who isn't talking at the expected age.

Medical devices used during rehabilitation or habilitation fall into the category of “durable medical equipment” and include walkers, wheelchairs, and hospital beds.

Here are the members of the rehabilitation and habilitation health team, and how you can find the right professional -- or combination of professionals -- for your needs.

In general, each member of the team and devices are covered by health insurance plans -- however, you should carefully read the details of your individual policy. The number of visits with each professional and co-pays may differ by the plan that you choose.

1. Physical therapists

Physical therapists help improve or restore mobility, and they teach people how to manage their conditions with a focus on balance and movement.

They work with a variety of patients including those who have suffered a stroke, orthopedic problems such as a broken hip, or a heart attack.

In some settings, physical therapists manage wound care, such as dressing wounds and helping patients avoid pressure on areas with open sores.

You may want to see a physical therapist if you feel like you’re having problems with moving your body (for example lifting arms above shoulder or walking) or if your daily activities, such as exercise or working around the house are causing pain, says Michael Shoemaker, vice president of the Michigan Physical Therapy Association and an associate professor of physical therapy.

2. Occupational therapists

Occupational therapists focus on life skills and daily living activities.

For example, someone who was in a car accident or someone who suffered a stroke may work with an occupational therapist to relearn life skills like grooming, using the toilet, cooking and getting dressed.

"We teach you a new way of doing the things that you've always done," says Denise Churchill, an independent occupational therapist in California specializing in home health.

Adaptive aids such as dressing sticks are sometimes used to help patients put on pants, socks and shoes. “Reachers” are lightweight, stick-like devices with grabbers at the end which help patients pick up objects.  

It can be helpful to work with occupational therapists in an outpatient facility because more tools and equipment are available, Churchill says. However, some patients aren't well enough to travel, so in-home therapy is a better solution.

In these cases, portable tools such as hand weights and exercise bands may be used in therapy.

3. Speech-language pathologists

Speech-language pathologists work with children and adults to prevent, diagnose, and treat speech-related disorders.

They may work with people who have problems with social communication and swallowing, says Gennith Johnson, associate director of health care services in speech-language pathology for the American Speech-Language Hearing Association.

For adults, a speech-language pathologist would be consulted if a patient experiences a loss of speech, language, swallowing, or cognitive function due to illness or injury.

A speech-language pathologist would provide services to a child if he or she has a congenital condition such as a cleft palate, problems with stuttering, or an illness or injury that affects their ability to develop age-appropriate speech, language, swallowing or cognitive functions.

4. Psychiatric rehabilitation

The Psychiatric Rehabilitation Association, a professional association for psychiatric rehabilitation professionals, defines psychiatric rehabilitation as promoting the recovery, independent living, and quality of life for people with mental health conditions that seriously impact their ability to lead meaningful lives.

These conditions may include major depression, schizophrenia or bipolar disorder.

“Psychiatric rehabilitation is about the whole person -- recreation, social, spiritual, education, and vocation," says Debbie Plotnick, senior director of state policy for Mental Health America.

Social workers, peer counselors and psychologists can get specialized training and certification in psychiatric rehabilitation.

The overall goal is to help people living with mental illness develop the social, emotional and practical skills needed to live independently in the community, according to Wulf Rössler, author of Psychiatric Rehabilitation Today: an overview.  

To find a rehabilitation professional in your area, please check with your health insurance plan, primary care physician, or professional organizations like the American Physical Therapy Association.

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