Long Term Care Planner: Individual 
Medicare Payments for Long Term Care:
Make Sure You Get Full Benefits and Coverage.
The first source of medical expense payments for most elders is Medicare. Medicare Part A pays for inpatient hospital care, and for "extended care" in skilled nursing facilities, as well as hospice care, and home health care.
Medicare pays for "extended care" in a nursing home IF the elder was hospitalized for at least 3 days (not counting day of discharge) before being admitted to the skilled nursing facility. Admission to the nursing home must be within 30 days of the hospital discharge. Medicare coverage also pays for skilled care by hospital staffs and physicians.
Do you know the extent of your right to coverage under Medicare? . Medicare Part A will pay for a limited number of days in a skilled nursing facility, and there are co-pays after the 20th day. At some point, you or your family may be confronted by hospital or nursing home staff, who tell you that Medicare will not continue to pay for care. They may refer you to Medicare Regulations that say the patient's condition must be expected to improved in a reasonable and predictable period of time based on the physician's assessment. If the patient has reached what the hospital or nursing home staff people think is maximum improvement, they decide to tell family members that Medicare will no longer pay the bill.
But there are many Medicare Regulations that protect your rights to continued coverage. Medicare regulations also say "the determination of whether skilled nursing care is reasonable and necessary must be based solely upon the beneficiary's unique condition and individual needs, without regard to whether the or injury is acute, chronic, terminal, or expected to last a long time." So, you have important rights to health care services that Medicare does cover.
Medicare
2012 Nursing Home
Co-Pay for Days 21-100: $144.50
Click Here for Past Years Medicare has co-payments for
each nursing home day.
Here's what the Original Medicare Plan
requires
you to pay during each benefit period
("spell of illness")
in a
Skilled Nursing Facility: Days 21 - 100 - $144.50 Beyond the 100th day: To learn how all of your resources can be coordinated, call for an appointment: |
Click Here for Examples of Nursing Home Rehab Patients who can get Medicare coverage under Medicare Regulations.
Examples: A patient with congestive heart failure may require continuous close observation to detect signs of decompensation, abnormal fluid balance, or adverse effects resulting from prescribed medication(s) that serve as indicators for adjusting therapeutic measures. Similarly, surgical patients transferred from a hospital to an SNF while in the complicated, unstabilized postoperative period, for example, after hip prosthesis or cataract surgery, may need continued close skilled monitoring for postoperative complications and adverse reaction. Patients who, in addition to their physical problems, exhibit acute psychological symptoms such as depression, anxiety, or agitation, may also require skilled observation and assessment by technical or professional personnel to ensure their safety or the safety of others, that is, to observe for indications of suicidal or hostile behavior. The need for services of this type must be documented by physicians' orders or nursing or therapy notes. Source: 42 CFR §409.33 / PDF. The Law Office of John L. Roberts can help you and your family protect your rights, and appeal Medicare eligibility denials. Call (413) 567-5600. |
As part of our services, we show you how to protect your rights, and coordinate your Medicare benefits with other sources of payment for elder care. Your case deserves individual attention, to make sure you receive the full benefits provided by Medicare.
Call us at (413) 567-5600.
Download the Elder Care Planner for Single People and Married Couples. Get More Information on Medicare Part D for Prescriptions.
Click for More Information on Medicare Part A Premiums.
Most people do not pay a monthly Part A premium, because they (or their spouse) has 40 or more quarters of Medicare-covered employment. For people who have only 30-39 quarters of Medicare-covered employment the Part A premium is $254.00 per month. The Part A premium is $461.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment. |
Click for More Information on Medicare Part B, and Part B Premiums.
Medicare Part B medical insurance covers physician care. Most beneficiaries will continue to pay a $99 monthly premium duriing 2012. Higher income people pay more. |
More Medicare Resources
Apply for Medicare without Retiring Medicare & You Booklet for 2011 Find and Compare Medicare Health Plans Booklet on Medicare Coverage for Glossary of Medicare Terms Medicare Hospice Regulations |
