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Medicare News
Senior Citizens Need to Know Medicare's Nursing Home Care
is Very Limited
ElderLawAnswers.com says Medicare covers "acute" care as opposed to
custodial care
 Jan. 18, 2008 - Many people believe that Medicare
covers nursing home stays. In fact Medicare's coverage of nursing home
care is quite limited. Medicare covers up to 100 days of "skilled
nursing care" per illness, but there are a number of requirements that
must be met before the nursing home stay will be covered. The result of
these requirements is that Medicare recipients are often discharged from
a nursing home before they are ready.
In order for a nursing home stay to be covered by
Medicare, you must enter a Medicare-approved "skilled nursing facility"
or nursing home within 30 days of a hospital stay that lasted at least
three days.
The care in the nursing home must be for the same
condition as the hospital stay. In addition, you must need "skilled
care." This means a physician must order the treatment and the treatment
must be provided daily by a registered nurse, physical therapist, or
licensed practical nurse.
Finally, Medicare only covers "acute" care as
opposed to custodial care. This means it covers care only for people who
are likely to recover from their conditions, not care for people who
need ongoing help with performing everyday activities, such as bathing
or dressing.
Note that if you need skilled nursing care to
maintain your status (or to slow deterioration), then the care should be
provided and is covered by Medicare. In addition, patients often receive
an array of treatments that don't need to be carried out by a skilled
nurse but which may, in combination, require skilled supervision.
For example, the potential for adverse interactions
among multiple treatments may require that a skilled nurse monitor the
patient's care and status. In such cases, Medicare should continue to
provide coverage.
Once you are in a facility, Medicare will cover the
cost of a semi-private room, meals, skilled nursing and rehabilitative
services, and medically necessary supplies. Medicare covers 100 percent
of the costs for the first 20 days.
Beginning on day 21 of the nursing home stay, there
is a significant co-payment ($128 a day in 2008). This copayment may be
covered by a Medigap policy. After 100 days are up, you are responsible
for all costs.
If you are in a nursing home and the nursing home
believes that Medicare will no longer cover you, it must give you a
written notice of non-coverage. The nursing home cannot discharge you
until the day after the notice is given. The notice should explain how
to file an expedited appeal to a Quality Improvement Organization (QIO).
A QIO is a group of doctors and other professionals
who monitor the quality of care delivered to Medicare beneficiaries. You
should appeal right away. You will not be charged while waiting for the
decision, but if the QIO denies coverage, you will be responsible for
the cost. If the QIO denies coverage, you can appeal the decision to an
Administrative Law Judge (ALJ). It is recommended that a patient hire a
lawyer to pursue an appeal.
● Last Updated by
ElderLawAnswers.com: 1/17/2008 For updates
click here
More links at ElderLawAnswers.com.
●
Home Page
● To find
a qualified elder law attorney,
click here.
● For a
related article on how Medicare beneficiaries can fight a hospital
discharge,
click here.
● For
more information on Medicare,
click here.
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Theres a widespread misconception that Medicare
pays for long-term care