Count On Medicare?

ACTHOMPSON.com

Can you count on Medicare?

You cannot count on Medicare to pay your bills

You must have been hospitalized for at least 3 days prior to entering nursing home, now counting the day of discharge. If you have not met this requirement, Medicare cannot consider your claim.
The individual must be admitted to the nursing home within 30 days of hospital discharge.
The nursing home must be a "licensed", "skilled" nursing facility that is Medicare-approved. If the nursing facility is not a licensed skilled-care facility, Medicare cannot consider your claim.
(Many areas of the country do not have many skilled Medicare-approved skilled-nursing facilities available. Large metro areas normally have the most)
The person must be receiving "skilled care", or Medicare cannot give your claim any consideration.
(95% of nursing home patients are receiving custodial care, 4.5% intermediate care - not skilled care. One half of 1% of all nursing home patients are receiving skilled care)
There’s one catch - Medicare must determine the care is "restorative in nature". This is "Medicare’s Judgment Call". Even if a person had been on claim and their condition deteriorates, Medicare will cease payment as of the date the condition deteriorated. This is because Medicare does not see care given for a worsening health condition or "routine terminal care as "restorative care". You can easily see why much of "skilled" care is not given any consideration by Medicare; so much of it is not restorative in nature.

What will Medicare pay you if you qualify for benefits?

Medicare will pay 100% of skilled "restorative" nursing home care from day one through twenty. If the person is still receiving skilled "restorative" nursing home care past the 20th day, the person or the person’s Medicare Supplement coverage pays the first $95.50 from the 21st day to the 100th day. Medicare pays the balance during those 80 days...after that, Medicare pays nothing!

So there you have it, Medicare may pay 100% of only the first 20 days, and only for the skilled care considered restorative by Medicare. You are responsible for the first $95.50 a day, in 1997, from the 21st through the 100th day, and Medicare blows out completely after the 100th day. This is why Medicare pays approximately only 4% of the nursing home charges.

FACT: ACCORDING TO THE HARVARD UNIVERSITY STUDY SPONSORED BY AARP, 79% OF THE SENIORS IN THIS COUNTRY MISTAKENLY BELIEVE MEDICARE WILL PAY FOR ALL OF THEIR NURSING HOME EXPENSES.

To qualify, these eligibility requirements must be satisfied.

Part-time or intermittent home health care is covered. Medicare does not pay for 24-hour care.
The patient must be homebound, which is having a medical condition that restricts one’s ability to leave the house except with assistance.
The patient must be under a physician’s care and that doctor must certify the need for home health care.
Medicare must certify the home health care agency providing the services.

Covered services include: part-time or intermittent skilled nursing care, physical therapy, speech therapy, occupational therapy, medical social services under the direction of a physician, medical supplies, part-time or intermittent services of a home health aide and 80 percent of the cost of durable medical equipment.

Specifically excluded from coverage is: full-time nursing care, meals delivered to the home, prescription drugs, 20 percent of the cost of durable medical equipment and homemaker services primarily needed to assist in meeting personal care or housekeeping needs.