If you are on Medicare and spend 3 days (midnights) admitted to a hospital, you will qualify for rehabilitation in a nursing home. Consequently, Medicare will pay the first twenty days, and you will be in a co-pay with Medicare up to 100 days. However, the trend is, hospitals are under significant pressure from Medicare to fully treat a person once they are “admitted” to the hospital. There are guidelines that the hospital has to meet basically to ensure that person stays healthy once they are dismissed from the hospital. Therefore, hospitals are bringing a person in for “observation” for…
CMS has a wealth of publicly available summary statistics regarding enrollment, spending, treatment patterns, cost sharing and other topics for both Medicare and Medicaid beneficiaries. This information can be accessed through the Medicare & Medicaid Statistical Supplement website. The site includes statistics on the following topics: Personal Health Care Expenditures Medicare Enrollment Medicare Program Payments Medicare Cost Sharing Medicare Short Stay Hospitals Medicare Skilled Nursing Facilities Medicare Home Health Agencies Medicare Hospices Medicare Physician Services Medicare Hospital Outpatient Services End Stage Renal Disease Medicare Managed Care Medicaid Medicare Part D There is data available from 2001 to 2010.
A study published in the Journal of the American Medical Association, found that in regions of the U.S. that tend to spend the most on end-of-life care, patients who have "advance directives" cost Medicare about $5,600 less per person. (Advance directives allow patients to communicate their end-of-life wishes if they are unable to do so themselves.) These patients' quality of life also appeared to be better; they were more likely to receive hospice care and to be at home when they died. But the differences in spending and care did not hold up in regions of the country with low-…
This is a drug prescription plan. It went into effect on January 1, 2006 with the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. But it has been amended, as we'll see in a bit. In essence, Part D moves some costs of prescription drugs to patients through what is called the "donut hole" or coverage gap. In order to receive Part D, a person with Medicare must enroll in a stand-alone Prescription Drug Plan or the Medicare Advantage plan with prescription drug coverage. These plans are regulated by Medicare, but are designed and run by private health…
There's Original Medicare and Medicare Advantage Plans, also called Part C. Original Medicare is in two sub sections—Medicare Part A and Part B. People can choose to have either one, or both parts. Paying a deductible is required for either one, and usually a patient must pay a fee each time they get services. Medicare prescription drug coverage (Part D) can be added by joining a Medicare Prescription Drug Plan. Costs and benefits vary by plan. (see below for more on Part D) A Medicare Supplement Insurance policy can be purchased to help pay some of the health care costs,…
Medicare has two main parts. There's Part A and Part B. Part A is for hospital coverage, and Part B is for medical coverage, such as seeing a doctor. Part A helps pay for in-patient care you get in a hospital, skilled nursing facility, or hospice, and for certain conditions of home health care. Medicare Part B helps pay for medically-necessary doctors’ services and other outpatient care. It also pays for some preventive services, like flu shots. It's important to note that neither plan pays full coverage for a patient's care. Medicare has premiums, deductibles and co-insurance, which must be…
“Up to 100 days” of coverage for rehabilitation does not guarantee 100 days. Up to 100 days of coverage rarely means 100 days. Often insurers discontinue therapy benefits after 2 to 8 weeks. They might say the patient has “plateaued” in treatment, not showing measurable improvement on a weekly basis. However the correct legal standard is aslong as the patient shows improvement or the therapy prevents deterioration. Many times therapy ends before it should. When Medicare therapy ends, if the resident stays in rehab or in a nursing home, then she must pay privately or, if assets are low enough,…
To receive up to 100 days of rehabilitative treatment either in a rehab facility, nursing home, or at home, generally, you need at least 3 days inpatient hospitalization. Consequently, if you are in the hospital for two days or less, you may not qualify for this Medicare benefit and will pay privately. When calculating three days of inpatient care, consider three “midnights” and make certain the time was spent as an inpatient and not in the emergency room or “under observation.” Although, in the hospital, sleeping over, and if you’re not “admitted” you are not considered eligible. If “under observation”…
Here are some important tips: You can Appeal your Discharge. If you are too sick to leave the hospital or if there is no place suitable to go, you can appeal your discharge to Medicare. The hospital should inform you of all your legal rights, appealing the discharge is one of them. Have your Power of Attorney or an advocate deal with the hospital discharge planner and make sure, if you leave the hospital that the place where you’re going you will get the right kind of care. Elder care attorneys can also assist you. Ask Your Doctor Decisions regarding…
Are you (or a loved one) a Medicare beneficiary? If yes, then likely you already know that it doesn’t always cover all the costs in a time of crisis. That’s why there are Medigap policies. Unfortunately, Medigap policies might just be the next thing to get Congress’s unwanted attentions according to a recent article through the Kaiser Health News. A Medigap policy is actually a private, supplemental form of insurance to cover medical bills Medicare doesn’t cover. Medigap is especially important in a crisis, since it can kick in for hospital visits that otherwise would go uncovered. Accordingly, this can…
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