Did you know that discharge planning and billing begins when you enter the emergency? This is an excellent time to review your health care coverage. Check to see what your coverage does and does not cover. What is the co-payment for an ambulance to the emergency room, to be seen at urgent care, or to see a medical doctor, specialist, lab workup, and diagnostic exams like an MRI, Cat Scan, or x-ray.?
Does your coverage cover rehabilitation in the home, at a rehabilitation center, or nursing home? Is Hospice services covered in-home or at a facility? Are home care, home health aide, d respite services covered? If so, what is the length of time? Can you pay privately for respite care?
You have just been told that your loved one will be transferred from the hospital to the nursing home for rehabilitation. You have some concerns, will rehabilitation services be covered by Medicare, Medicaid, or other health insurance? How long will the coverage pay for these services before you are responsible for a daily co-payment of $300-$500 a day? One of the biggest misconceptions about Medicare is that it provides long-term nursing home coverage. It doesn’t.Medicare covers only limited periods of inpatient care, only in a skilled nursing or rehabilitation facility following a hospital stay, and only under strict guidelines. Still, Medicare nursing home coverage can be vital if the person you’re caring for has just been hospitalized. Medicare can pay for costly short-term, intensive rehabilitation, which in turn can give you a chance to arrange for longer-term care if it’s needed.
One of the reasons many people mistakenly believe that Medicare covers long-term custodial care is that it is easily confused with Medicaid, a separate program. Unlike Medicare, Medicaid can cover long-term care, either in a nursing home or home. Medicare nursing home coverage is a standard part of Medicare A. Anyone enrolled in Medicare Part A can receive Medicare nursing home coverage if they qualify for it. There’s no special paperwork needed to apply for Medicare nursing home coverage; the nursing home itself handles all the administration. If the person you’re caring for is enrolled in a Medicare Part C Medicare Advantage Plan, they will cover nursing home care.
For the first 20 days in a facility, Medicare pays all covered charges. For days 21 to 100 in a nursing facility, Medicare pays all covered costs except a daily “coinsurance amount” for which patients are personally responsible. If the patient has a private Medigap supplemental insurance policy, that policy might pay some or all this coinsurance amount. After 100 days in a covered skilled nursing facility, Medicare no longer bears any cost.
Does all this sound confusing? Please join us on March 17, 2022, at 7 pm for our upcoming 45 mins “Let’s Talk” informational session. Topic: Medical coverage for Nursing Home services. Presenter: Lourdes Gonzalez, Director from Regis Care Center.