Medicare

My mother needs assistance with bathing and dressing at home. Will Medicare provide this care? In general, Medicare does not provide custodial care where the primary need is to assist the patient with Activities of Daily Living (or ADLs). They do not offer this care unless there is a concurrent need for skilled nursing care or therapy. Custodial care is often provided for a limited time after hospitalization if there is also a need for skilled nursing care or therapy. However, even if there is a skilled need, Medicare has recently cut back drastically on the amount of custodial care approved.
If my mother cannot manage at home and needs to go to a nursing home, will Medicare pay for these services? In general, Medicare does not provide for long-term care in a nursing home. However, do not confuse this with rehabilitation services provided by Medicare for a limited time after hospitalization of three days or longer.
My father just had a hip replacement. He is not able to be at home alone. Will Medicare pay for his care in a rehabilitation facility? If there is a need for skilled care or therapy after a minimum of three days hospitalization for an illness or injury, traditional Medicare will pay for 20 days in a rehabilitation facility. These facilities are sometimes associated with a nursing home. If your father still needs skilled care or therapy after 20 days in a rehabilitation facility, and Medicare determines that he/she continues to improve, Medicare will pay part of the cost for an additional 80 days - - but your father will be responsible for a co-payment. If your father has an appropriate Medigap policy, that insurer will pick up the co-payment.
What is Medigap? Medigap is private insurance intended to supplement traditional Medicare insurance. There are several plans, each offering a different range of benefits. These plans can be helpful in paying deductibles and co-payments that Medicare does not cover. Some plans cover the co-payments for days 20 – 100 in a rehabilitation facility. It is important that you and your parents review the cost and benefits of each plan before enrolling.
Tips: Choose a Medigap plan that offers automatic crossover. Medigap payments will be automatically sent to the medical provider and you will not have to submit additional insurance claims. If your parent lives alone, seriously consider a Medigap plan that covers the copay for days 21-100 in a rehabilitation facility. Medicare has become increasingly strict in assessing whether a patient is making progress in a rehabilitation facility. Medicare will discontinue payment if they determine that there is no improvement or it therapy is primarily for maintenance. If your parent receives a written notice that Medicare will no longer pay for care in a hospital or rehabilitation facility, it is important to take action immediately. If you believe that your parent needs additional care, take immediate steps to appeal this decision.
For a thorough discussion of Medicare options consult: Medicare and You, a publication of CMS/Medicare www.Medicare.gov www.medicarerights.org Medicare Rights Center Hotline: 800-333-4114