Ask the Expert- Is Medicare Enough to Cover Mom's Nursing Home Stay?
Published: Fri, 04/12/13
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Ask the Expert- Your Elder Law Questions Answered by Evan H. Farr, CELA |
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Ask the Expert- Is Medicare Enough to
Cover Mom's Nursing Home Stay?
 Q. My 86 year old mother had a stroke last week, was in the hospital,
and was moved to a nursing home for rehabilitation. I was
wondering about Medicare coverage. Does Medicare cover nursing
home stays? What if she needs more than the 100 days I read about?
A. Many people believe that Medicare covers nursing home stays. It is true
that Medicare covers up to 100 days of short-term rehabilitation per illness, but
there are a number of requirements that must be met before this short-term
rehab stay will be covered. The result of these requirements is that Medicare
recipients are often discharged from a nursing home before they are ready.
In order for a nursing home stay to be covered by Medicare:
· The patient must enter a Medicare-approved "skilled nursing facility" or nursing home within 30 days after a hospital stay that lasted at least three days.
· The short-term rehabilitation care received in the nursing home must be for the same condition as the hospital stay. In addition, you must need "skilled care." This means a physician must order the treatment and the treatment must be provided daily by a registered nurse, physical therapist, or licensed practical nurse.
· Finally, Medicare only covers "acute" care as opposed to custodial care. This means it covers care only for people who are likely to recover from their conditions, not care for people who need ongoing help with performing everyday activities, such as bathing or dressing.
It is important to understand that Medicare does not pay one penny for
long-term care. (This section is excerpted from Evan H. Farr, CELA's book
"Nursing Home Survival Guide- Helping You Protect Your Loved Ones Who
Need Nursing Home Care by Preserving Dignity, Quality of Life, and
Financial Security," available on Amazon.com)
"If you are enrolled in a traditional Medicare plan, and you've been in the
hospital at least three days, and you are admitted directly from the
hospital into a rehab facility (which are typically skilled nursing facilities)
for short-term rehabilitation (i.e., therapy and treatment designed to
make you better), then Medicare should pay the full cost of this short-
term rehab stay for the first 20 days, and may continue to pay part of the
cost of the short-term rehab stay for the next 80 days -- with a per day
deductible that you must pay privately (although there are Medicare
supplement insurance policies that sometimes cover that deductible).
There is also a Medicare Managed Care Plan, for which the 3-day hospital
stay may not be required, and for which the deductible for days 21
through 100 is waived, provided certain strict qualifying rules are met.
But whether the plan is traditional Medicare or Medicare Managed Care
(MMC), the nursing home resident must be receiving daily rehabilitative
care and must be improving. Medicare does not pay for long-term care,
i.e., for custodial nursing home stays or in-home care.
In a best case scenario, traditional Medicare or MMC will provide some
coverage for the hospital stay and rehabilitation of up to 100 days for
each "spell of illness" (although in our experience coverage usually falls
far short of the 100-day maximum). If you recover sufficiently that you do
not require a Medicare-covered care benefit for 60 consecutive days, you
may be eligible for another benefit period, i.e., another 100 days of
Medicare coverage, but the illness or disorder must not be a chronic
degenerative condition from which you will not recover.
What happens if you've used up the 100 days of coverage and still need
more rehabilitation, or if you need to move into long-term nursing home
care? You're back to one of the alternatives outlined above: long-term
care insurance, paying the bills with your own assets, or qualifying for
Medicaid."
month? For typical middle-class people who pay out of pocket, these
costs will most likely drain all of their hard-earned assets pretty quickly.
For more information, read our recent blog post "How Can I Afford a
Nursing Home?".
Do you have a loved one who is in a nursing home or nearing the need
for nursing home care? Or are you simply looking to plan ahead in the
event nursing home care is needed in the future? Life Care Planning and
Medicaid Asset Protection is the process of protecting your assets from
having to be spent down in connection with entry into a nursing home,
while also helping ensure that you or your loved one get the best
possible care and maintain the highest possible quality of life, whether
at home, in an assisted living facility, or in a nursing home. Learn more
at The Fairfax Elder Law Firm of Evan H. Farr, P.C. website. Call 703-691
1888 to make an appointment for a no-cost consultation.
 Critter Corner- Featuring Big Red the Betta Fish
Dear Big Red,
We are looking for assisted living facilities for my dad. The brochures are nice, but I really want to find a good fit for him. What are some questions we should ask when we visit the facilities?
Thanks!
Candice B. DePlace
-------- Dear Candice,
If you're in the market for assisted living housing you've seen your fair share of glossy promotional materials. And, while it's nice to find a well landscaped facility with new carpet, it's more important to fully understand a facility's policies and practices to see if it is a good fit. When you're at a facility make sure to ask some deeper questions such as the following:
Also, what could be a better indicator than your own observations and gut feelings. Keep these things in mind when you are visiting assisted living facilities:
What to look for in the staff:
What to look for in the residents:
In the book, The Nursing Home Survival Guide- Helping You Protect Your Loved Ones Who Need Nursing Home Care by Preserving Dignity, Quality of Life, and Financial Security," Evan H. Farr, CELA, provides invaluable information and guidance to families dealing with the possibility of nursing home care and struggling to make the best decisions for themselves or their loves ones. If you are looking at Nursing Homes (or Assisted Living Facilities), Mr. Farr provides access to a valuable Nursing Home Evaluation Tool. Readers will also become educated about the rights of nursing home residents, estate and Incapacity Planning, How to Find the Best Lawyer, and more. The "Nursing Home Survival Guide- Helping You Protect Your Loved Ones Who Need Nursing Home Care by Preserving Dignity, Quality of Life, and Financial Security" is now available on
Amazon.com.
Be sure to plan ahead, should the unexpected happen. Call 703-691-1888 to make an appointment for a no-cost consultation.
For some stress relief and to see me and some equally adorable Siamese cats (Saki and Alley) and a bunny (Commander Bun Bun), we encourage you to stop by The Law Firm of Evan H Farr and pet us all (except me, the fish, of course!). Looking forward to seeing you soon!
P.S. Don't forget about your pet! Evan Farr just posted about Pet Trusts in Everything Elder Law. Check it out here! About Big Red:
Big Red has lived at The Farr Law Firm for two years, and he belongs to Evan and Jeannie Farr. He resides on the table behind Jeannie's desk and his bowl can often be found on the hall table when you get off the elevator. He loves socializing with the African Dwarf Frogs (Ernie and Jannette) and greeting all of the clients that come to the firm. |
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