By James E. De
Martino
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 $119.00 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. |
