Medicare: Do You Know All You Should?
Nursing Care Benefits
When they turn 65, many people are more concerned about needing and paying for nursing care than a hospital stay. Medicare does provide some relief in this area. Medicare will pay for up to 100 days per benefit period for "skilled" nursing care services or rehabilitation services in a nursing home. You should be certain that all of the care, nurses and facilities are on Medicare's approved list, in advance of your admission, or use, since this will help to prevent disputes with Medicare over coverage issues later. For example, hiring a trainer three times a week at your health club to rehabilitate your severely sprained ankle may help your rehabilitation, but it will likely not pass muster with the folks at Medicare.
There are certain limits on the amount of care that is covered, and the amount of services which will be paid by Medicare in this area. Generally, the first 20 days of care are covered by Medicare with no payment by you. Thereafter, a daily deductible is paid by the person receiving the services and care for days 21 - 100.
The services and care covered are defined by the federal rules and regulations governing Medicare. In addition, certain coverages may vary by state, and of course, are subject to change. Covered services in this area generally include registered nurses, physical, speech and vocational therapy, medications, medical devices, medical treatment and medical supplies and equipment. If you have a question regarding whether a particular person's services are covered, it would be wise to seek counsel from a lawyer or assistance from Medicare, before incurring the costs of 100 days of treatment.
The nursing home aspect of Medicare coverage also has certain other requirements in order to be covered. First, the nursing home coverage must fit the definition of "skilled nursing care" as set forth in the appropriate regulations and laws. Second, prior to any nursing care being covered, the patient must have been confined to a hospital for 3 days at the minimum. Third, the nursing home must be entered within 30 days of leaving the hospital. Finally, there is a requirement that you be treated in the nursing home for the same condition for which you were treated in the hospital.