MEDICARE
Medicare is one of the most misunderstood government programs when it come to long term care planning. Most people will think MEDICARE covers all long term care expensive. When in reality they virtually cover nothing. what they will cover is for 100 days of skilled rehabilitative care. Custodial care which most people will receive for things as alziemers, Parkinson's and ADL assistance MEDICARE covers nothing. Below is a breakdown of what Medicare covers.
MEDICARE SKILLED Nursing Facility Benefits
To be eligible for Medicare benefits in a skilled nursing home facility, the patient must meet the following requirements:
3 day hospital stay (not including the day of discharge)
Care needed must be skilled nursing rehabilitation services
Skilled Nursing Facility must be certified by Medicare
Physician must certify the need for this skilled care on a daily basis
If the patient qualifies for all these criteria, they can qualify for UP TO 100 days of Medicare benefits. Medicare will pay for the first 20 days at 100%. days 21-100 Medicare will pay for everything except a CO-pay. If the patient has a Medicare Supplement or an HMO this charge may be covered.
The average Medicare stay in 1999 was only 23 days. It is very rare for someone to get full 100 days of coverage. When skilled care is no longer needed, the care usually becomes custodial care. Medicare does not pay for custodial care in a nursing home.
MEDICARE HOME CARE BENEFITS
Medicare care will pay for care in the home if there are skilled services needed. The care needed can only be part time or intermittent home health care. Medicare will NOT pay for care longer than a regular visit to perform services. As an example, Medicare would not pay for a home health care aid to stay for 8 hours or a 24 hour shift. The requirements for home health care are as follows:
Medicare defines intermittent care as skilled nursing care that is provided on fewer than even days each week, or less than eight hours each day (combined) for 21 days or less.
The patient must be homebound. This is defined a s a medical condition restricting the ability to leave the house except with assistance-or if it is medically inadvisable to leave the house.
The patient must be under a physicians care and the physician must certify the need for the home care.
The home health agency providing the care services must be certified by Medicare.
If you have questions about MEDICARE programs you can call the Social Security Administration at 800-772-1213. They can answer questions about eligibility
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