By Rick Banas of BMA Management, Ltd.
When I heard my family member’s question about Medicare, I was not surprised.
His sister needed to move from the apartment in a retirement community where she was living into a nursing home. He was trying to verify how much of the cost of nursing home care would be covered by Medicare.
I had to explain that Medicare would not be paying a dime. The reason why is because his sister needed nursing home care because of Alzheimer’s.
People often think that because “Mom has Medicare, she will be covered for her whole stay in a nursing home,” said Janet Dobbs, Administrator of the Douglas Nursing and Rehabilitation Center in Mattoon, Illinois. She was talking about Medicare and Medicaid during an informational program at the Heritage Woods of Charleston affordable assisted living community that BMA manages in Coles County, Illinois.
She emphasized that “just because you are in a nursing home does not mean you will be covered.”
Medicare benefits for skilled nursing only applies for short-term rehabilitation and only if you meet certain eligibility requirements:
You must be receiving care in a Medicare-certified skilled nursing care bed.
You must be moving into the nursing home after being in a hospital as an “inpatient” for at least three consecutive midnights.
You must need rehab and be making adequate progress toward recovery or partial recovery.
If you have traditional Medicare and you meet the eligibility requirements, Medicare will cover 100% of the costs of skilled nursing care for the first 20 days. For days 21 through 100, there is a daily co-pay. This year, the amount is $152 a day. Medicaid and most Medi-gap policies will pick up the co-pay amount, Dobbs said.
If you have Medicare coverage through a Medicare Advantage Plan, be sure to check with your plan about the specifics of what is covered.
Here is one more important point that Dobbs mentioned about hospitalizations.
Don’t assume that just because you are in a bed in a hospital room that you are considered an inpatient. These days, you might be in the hospital for five nights, but you may not be in the hospital as an inpatient for the three midnights required by Medicare, said Dobbs.
You may be in the hospital under “observation status” rather than as an “inpatient” so you should check with the hospital.
Whether you are in the hospital under “observation” or as an “inpatient” is not only important in regards to skilled nursing care benefits for rehabilitation. It also is important in regard to your hospital bill.
If you are considered an “inpatient,” Medicare Part A covers the cost. If you are considered under “observation status,” Medicare Part B coverage applies and significant co-payments may be involved.
For more information, go to www.medicare.gov, which is the official U.S. Government site for Medicare.
Also, the 2014 Medicare Open Enrollment period runs from now through Dec. 7. I encourage you to review and compare your coverage options for 2015.
All affordable assisted living communities managed by BMA Management, Ltd. are certified and surveyed by the Illinois Department of Healthcare and Family Services. All assisted living communities are licensed and surveyed by the Illinois Department of Public Health.
“BMA Management, Ltd. is the leading provider of assisted living in Illinois
and one of the 20 largest providers of assisted living in the United States.”
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