|
| |
| |
What
About Medicare?
There is a great deal of confusion
about Medicare and Medicaid.
Medicare is the federally funded and state administered health
insurance program designed for older individuals (i.e. those over age
65). There are some limited long-term care benefits that are available under Medicare. In general, if you are enrolled in the
traditional Medicare plan, and you've had a hospital stay of at least
three days, and then you are admitted into a skilled nursing facility
(often for rehabilitation or skilled nursing care), Medicare may pay
for a while. If you are a Medicare Managed Care Plan beneficiary, a
3-day hospital stay may not be required to qualify.)
If you qualify, traditional Medicare may pay the full cost of the
nursing home stay for the first 20 days and continue to pay the cost
of the nursing home stay for the next 80 days, but with a deductible
that's nearly $128.00 per day. Some Medicare supplement
insurance policies may pay the cost of that deductible. For Medicare
Managed Care Plan enrollees, there is no deductible for 21
days through 100, as long as the strict qualifying
rules
continue to be met. So, in the best case scenario,
the traditional Medicare Managed
Care Plan must pay up to 100 days for each "spell of
illness". In order to qualify for this 100 days of coverage,
however, the nursing home resident must be receiving daily
"skilled care"
and generally must continue to
"improve". Note that once the Medicare and Managed Care
beneficiary has not received a Medicare covered level of care for 60
consecutive days, the beneficiary may be eligible for the 100 days of
skilled nursing coverage for the next spell of illness.
While it's never possible to predict, at the outset, how long Medicare
will cover the rehabilitation, from our experience, it usually falls
far short of the 100 day maximum. Even if Medicare does cover the 100
day period, what then? What happens after the 100 days of coverage
have been used?
At that point, in either case, you're back to one of the other
alternatives---long term care insurance, paying the bills with your
own assets, or qualifying for Medicaid. |
| |
|
|
James E. De Martino is licensed
to practice in the State of New Jersey.
We specialize in NJ Medicaid and Asset Protection legal services. |
|
|
