When Does Medicare Pay For Nursing Home Care?

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One of the most common phone calls I receive in the office is when someone's mum or father is admitted to the hospital. In this time of crisis, answers are not easy to come by.

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How is When Does Medicare Pay For Nursing Home Care?

We had a good read. For the benefit of yourself. Be sure to read to the end. I want you to get good knowledge from Kaiser Medical.

How does their health assurance work? What does Medicare pay for? Once the parent is discharged, what happens, where do they go, how is it paid for, what are our options? What do we do if mom or dad is going to have to go to a nursing home? How do we pay for it?

This blurring is unbelievable as the senior health care law can be a very confusing and extraordinary process. The first thing to do is to understand the basis for today's system.

In 1983, Congress created the Prospective payment System. This is foremost because when a person 65 or older is admitted to a hospital, he is assigned only one of 473 Diagnostic associated Groups (Drg's). This is foremost because Medicare compensates the hospital a flat dollar whole for the Drg assigned to the patient.

Let me give you an example. Say that my father is admitted to the hospital with lung problems and the Drg is four days. If my father is discharged in three days, then the hospital makes one day of profit. If my father is discharged in five days then the hospital loses money and cannot bill the patient for the one extra day.

Back in the good old days, I remember when my grandfather was in the hospital and the nurse asked him if he felt well adequate to go home because if he didn't, he could stay a few extra days until he felt better.

Today, it is all about the money. Once a patient is no longer getting good or worse, in other words, is deemed to be "stable", then the patient is discharged whether to home or a Medicare certified nursing home or rehab facility.

In order for Medicare to pay for rehab care the patient must have been in the hospital for three consecutive days (72 hours). Then, no later than thirty days after extraction from the hospital, be admitted to a Medicare certified nursing facility.

If these criteria are met, then for 2010, day's one straight through twenty in the rehab premise are paid for 100% by Medicare. For days twenty one straight through one hundred, your co pay is for this year is 7.00 per day.

From day 101 and beyond, regardless of your condition, you are responsible for all of the premise costs.

Keep in mind, that in order for this refund agenda to happen, you must whether be getting good or getting worse. Like the hospital, once you are deemed to be stable, you come off the Medicare refund agenda and must pay for all costs.

In California, most patients will come off of Medicare refund nearby week three and must begin incommunicable paying from this point forward. The company office will suggest you when this is unbelievable to take place.

If the premise has long-term care beds, then the patient may be able to stay in the same facility. But if the premise is strictly short-term care or rehab, then the patient must find someone else premise or go home.

How does the patient's health assurance fit into this? It all depends on what type of plan that the senior patient is on. Is it a Medicare supplement plan or Ppo, or is it a Medicare advantage plan like an Hmo?

Medicare supplement insurance, also called Medigap, is incommunicable health assurance designed to supplement Medicare. A prime is paid for this coverage which is age rated.

There are twelve standardized Medigap plans, A straight through L. In most states, you can go to any physician or hospital that accepts Medicare without pre-authorization. Under plans C straight through J, days one straight through twenty are thoroughly paid for by Medicare. For days twenty one straight through one hundred, the Medicare co-pay for 2010 is 7.00 which is covered by the Medigap policy. From day one hundred one and beyond, the patient is responsible for the full cost.

For Medicare advantage plans such as an Hmo like gather Horizons, Scan and Kaiser, the patients may have a co-pay from day eleven of 0. It is best check the benefits booklet or call the buyer aid department.

If person goes to a premise without going to the hospital first, then you must incommunicable pay from day one.

Once the patient comes off Medicare reimbursement, if qualified, Medi-Cal will help to pay for the nursing home costs. If going to the premise directly from home, then, if qualified, Medi-Cal may help to pay for the nursing home costs from day one.

Please consult with a Medi-Cal specialist for more information and the exact procedures.

Copyright 2010 by Karl Kim

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