Unfortunately, most people do not plan for the nursing home, until the crisis occurs. As an elder care attorney I see this situation time and again. Therefore, it is important to educate my clients on the options they have available. The nursing home is a strong possibility for most Americans. People are now living longer than they ever have before. Consequently, for most they cannot care for themselves. Therefore, you will need some form of long-term care, usually, the nursing home. We, if the need occurs, help you plan for how to make this possibility happen. Medicare does not pay…
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…
Who Will Be Subject to the New Surtax? One of the largest tax increases arising out of the President's health care reform initiatives is a new tax on the qualified unearned or passive income of individuals, trusts and estates. That tax begins January 1, 2013, will be imposed at a 3.8% rate and is designated as a Medicare contribution tax (the Medicare surtax). Initially advertised as applying only to high income individuals, the Medicare surtax also applies to estates and trusts once the taxable income reaches the top marginal tax rate. Estates and trusts reach the threshold for taxation at…
Making effective decisions about the care of a loved one often takes more time than expected and requires an understanding of the long-term-care system. But a proactive approach can yield better options when the time comes and can head off a family emergency: Talk early and often. Understand your parents’ preferences as they age. Don’t make assumptions about what type of care they may or may not accept. Instead, respect their autonomy. Rather than starting off with an admonition (for example, “You have to …”), lead with an empathic statement such as, “I am worried about you because … if…
“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,…
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