If you have an elderly loved one who requires skilled nursing care, it is important for you to understand what costs you will be responsible to pay and what Medicare might cover. The caring staff at Elder Care Direction can help you to understand the ways that you might be able to pay for your loved one’s care.
Medicare will not pay for long-term care
The first thing that you should understand is that Medicare will not pay for long-term care. Medicare instead pays for short-term care in skilled nursing facilities that are certified by Medicare. These types of stays normally happen when elderly people have been hospitalized and are sent to inpatient facilities for their recovery from an operation, injury, or illness upon their discharges. In some cases, a setback may require people who initially were discharged to a temporary skilled nursing facility setting may necessitate their placement in long-term care facilities.
Medicare’s measurement of skilled nursing care coverage
Medicare measures care in skilled nursing care facilities in something called benefit periods. Each period starts on the day that the person is admitted to a hospital. Once the time period starts, the person will have to have a minimum three-day inpatient stay to be eligible for the payment of care by Medicare in a skilled nursing facility. The benefit period ends once the person has received 60 days of treatment. A new benefit period can start again in the future if another hospitalization is later needed.
Qualifying patient criteria
In order to be eligible, a patient must meet the following criteria:
- Have Medicare Part A
- Have stayed on an inpatient basis in the hospital for three or more days
- Must go to the skilled nursing facility no later than 30 days after being discharged from the hospital
- Skilled nursing care must be ordered by the doctor
- The patient must require skilled nursing care each day
- The skilled nursing care must be needed for the same condition that was treated in the hospital
- The services must be necessary and reasonable
The amount that Medicare will pay
The coverage provided by Medicare decreases as time passes. For the first 20 days, Medicare will pay the full cost. For the days from 21 to 100, Medicare will pay everything except for the daily charge for coinsurance, which is $167.50 in 2018. Medicare will not pay anything after 100 days have passed.
Understanding Medicare’s standard
According to the government, Medicare coverage for skilled nursing facilities doesn’t depend on whether or not the beneficiary might recover. Instead, it depends on whether or not the patient needs skilled nursing care. Despite this, some skilled nursing facilities do not work to help patients with chronic conditions get the coverage for which they are eligible.
How to ensure that Medicare pays for skilled nursing facility care
The Medicare rules are complex and have been interpreted in multiple ways. In order to ensure that Medicare will pay, family members should expect to have to advocate for their loved ones to get the care that they need and the coverage that they should receive.
It is important to make certain that the staff at the hospital and the skilled nursing facilities write orders and reasons for the care that are detailed. You should also make sure to track the days of the benefit period carefully.
Getting help from the professionals at Elder Care Direction may be a good idea. They might help you to track the benefit period and help you to make certain that the staff provide detailed orders that are likelier to be accepted by Medicare. If your loved one’s benefit period is ending, Elder Care Direction may help you to find alternative placements and financial help to pay for them.
Contact Elder Care Direction
In addition to Medicare, there may be other resources that are available to help you to pay for your loved one’s skilled nursing care. If your loved one has a limited income, he or she may be eligible to receive coverage from Medicaid to pay for skilled nursing care or long-term nursing care. Contact Elder Care Direction today to schedule a consultation so that you can learn about the options that you might have.
