22- Jul2016
Posted By: Tony Fischer

What Does Medicare Cover?

Getting Medicare has turned into an aging milestone for most Americans.  For most, getting the government insurance card in the mail means you are officially retired. Every taxpaying citizen of the United States is automatically enrolled in Medicare when they are 65.  In fact you should be getting your care around 3 months before your 65th birthday.

Everyone knows what Medicare is but most still don’t understand what exactly it covers especially when it comes to senior care. This post will give you a brief summary of what types of senior care Medicare covers and for how long.

The Purpose of Medicare

Many assume that because you get Medicare automatically at age 65 that it covers all types of senior care including long-term care. But Medicare was only intended to cover short-term care services like those at the hospital or rehab center. In fact when it comes to long-term care, Medicare’s coverage is very limited and varies based on the type of care being received.

Read Related: How To Pay For Long-Term Care

Medicare is the Default Hospital Coverage for 65 Year Olds and Older

Medicare is the default hospital coverage for folks who are 65 years or older.  The length of stay depends on why the patient was admitted and how they respond to treatment.

Nursing Home Rehab

Today’s nursing homes offer two levels of care.  The level most people are familiar with is long-term care. That is when the patient (referred to as a resident) is expected to stay anywhere from 3 months to multiple years.

Short-term rehab (or Sub-Acute) is they type of care that requires interventions from a physical therapist or registered nursing.  Patients needing short-term rehab may be recovering from an extended hospital stay, stroke, heart failure, Chronic Obstructive Pulmonary Disorder or joint replacement just to name a few.

Doctors often recommend short-term rehab in a nursing home for seniors who cannot keep up with the pace of an inpatient hospital rehab unit.  That is not to say that patients in the nursing home rehab setting aren’t required to show progress.  In fact a patient must show progress and participate in therapy in order to keep their Medicare coverage.

Coverage can last up to 100 days if progress is being shown but even then Medicare doesn’t cover the entire bill.  Medicare covers 100% of a nursing home rehab stay for only 20 days.  If the stay lasts beyond 20 days, Medicare covers roughly 80% with the remaining 20% being covered by a Medi-Gap insurance or coming out of the patient’s pocket.

Home Care

When the senior is ready to discharge from the hospital or nursing home rehab; home care may be prescribed by the doctor.  Home Care is approved in 60-day increments and is typically covered 100% by Medicare. However like short-term rehab coverage the patient must show progress in therapy treatments.

Read Related: Home Care: How It Works.

Outpatient Rehab

If the patient doesn’t require a skilled nursing environment like that of a nursing home or meet the home bound criteria for Home Care, outpatient rehab may be needed.  Medicare covers outpatient therapy but co-payments may be needed depending on the type of diagnosis and length of care.  Check with the outpatient rehab clinic for coverage details.

More Questions?  Senior Care Sherpa Can Help

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21- Jul2016
Posted By: Tony Fischer

Home Care: How It Works

Home Care is the fastest growing segment of the senior healthcare continuum and for good reason. Seniors want great healthcare but they also want control.  With the negative stigmas surrounding nursing homes, seniors are often choosing care in their own home rather than care in a facility.

Nursing Home care has its place in the healthcare continuum but it is costly.  With monthly rates ranging between $8,500 to $15,000 many are opting to spend their healthcare dollars in the comfort of their own home. Medicare has also shifted healthcare dollars by cutting funding to nursing homes and funding pilot programs designed to promote home care innovations.

With so much opportunity comes competition.  Thousands of Home Care companies have sprung onto the market hoping to capitalize on the Baby Boomer retirement rush causing confusion for consumers and referral sources.

Every level of the senior care continuum has its place but large caseloads prevent social workers from spending the time it takes to explain how each level works.

In this post we will talk about home care, how it starts and how it works.

How it Starts

Home Care is covered by Medicare Part A. It is approved in 60 day increments called “certification periods”.  In order for someone to qualify for Home Care they must be homebound.  Homebound is defined by Medicare as an individual who is confined to home because …a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device… according to the Centers for Medicare Advocacy.

A patient doesn’t need to have a qualifying hospital stay in order to begin home care but they do need an order from a doctor.  That order can come at any time but must be prescribed specifically to treat a particular diagnosis. Additionally it must be explained to the patient why they are being prescribed home care treatment (called a face-to-face).

Home Care is an excellent tool if used to prevent a possible hospital stay.  If prescribed at the first sign of weakness or exacerbation of a chronic illness it can prevent the senior from entering a cycle of hospitalization.

How it Works

After the home care company receives the referral they have 48 hours to open the case.  In order to do that a nurse must go to the patient’s home to complete an evaluation.  After the case is opened a physical therapist and sometimes an occupational therapist will come out to complete their own evaluations.  After all the initial evaluations and paperwork is complete, the treatment team will decide on a schedule (also known as frequency) they will use to provide the physician directed treatment.

As with any other type of short-term health care insurance, coverage only continues if the patient continues to show progress. Coverage ends when the patient achieves their treatment goals or stops showing progress toward them.