“By Failing to Prepare, you Prepare to Fail” - Benjamin Franklin

Did you know Medicare never extends coverage to a patient who needs custodial care only? The custodial care may be provided as part of the Medicare skilled nursing home coverage that is partially provided by Medicare Part A. There are many restrictions, however, that apply to Medicare coverage for skilled nursing facility care. 

What you may not realize is that nursing care requires that the care must be provided by or requires the supervision of skilled nursing personnel or other skilled rehabilitation services. As a practical matter, this can only be provided in a skilled nursing home facility on an inpatient basis. 

For each spell of illness in 2019, Medicare Part A will pay all the costs for a covered skilled nursing home stay for the first 20 days. After that, it will cover all but $170.50 per day for up to an additional 80 days as long as all of the following conditions are met:

1. The individual was a patient in a hospital for three consecutive days, not including the day of discharge. In addition, the patient must be admitted to the skilled nursing facility within 30 days of discharge from the hospital. However, there are a few limited exceptions to the requirement that the admission must occur within 30 days of discharge from the hospital.

2. A doctor must certify that the patient needs skilled nursing home care.

3. The services are provided by or under the supervision of a trained individual.

4. The services are received on a daily basis, which means therapy services at least 5 days per week and/or nursing care 7 days per week.

5. The services are provided by a Medicare-certified skilled nursing facility.

6. The skilled services must be provided on an inpatient basis.

Remember, a Medicare beneficiary is entitled to receive coverage for all the skilled care in a nursing home for 20 days. A Medicare beneficiary is entitled to receive $170.50 of the cost of coverage for the next 20 days of skilled care in a nursing home. The Medicare beneficiary is not entitled to any coverage for skilled care in a nursing home beyond 100 days.

We know this raises questions for you. How will you be able to afford the skilled nursing facility bill? Where do you turn to for help? Should you ask your children to help? We want you to know that we are here to answer these questions. We work with Florida seniors and their loved ones each day as they handle these issues. Do not wait to contact our law office to schedule a meeting and find the answers you need.

The Department of Veterans Affairs offers a wide range of long-term health care services that can help military veterans of all ages manage their daily lives. If you are seeking this type of care for your veteran loved one, it is important to know that it can be costly, and the veteran must demonstrate a clinical need for long-term care support. For example, elder and disabled veterans are considered the primary beneficiaries, but eligibility is more broadly based on the need for ongoing treatment, personal care and assistance, and the availability of services in a given location. Other factors include financial eligibility, service-connected disability status, private insurance coverage, and the ability to pay. There are many factors to consider and financial commitments to be made, which is why we want to share three ways that can help your loved one pay for long-term care services.

First, veterans can pay through a standard VA medical benefits package. To be eligible for this specific package, however, those seeking long-term care support must be enrolled in VA health care before applying. This means that the veteran has already applied for health benefits, and receives care through a VA facility on a regular basis. It is important to consider, however, that simply receiving financial compensation for a VA disability does not automatically enroll a veteran in VA health care.

Medicare is another way to help afford long-term care. The federal health insurance program will help your loved one pay for services in a skilled nursing facility, as well as some in-home health services, as long as your loved one is enrolled in Medicare Parts A and B.

“Original Medicare” may pay for up to 100 days per benefit period for skilled health care after a Medicare-supported hospital stay. The nursing facility must be certified by Medicare and provide services by skilled nursing or rehabilitation staff, such as a nurse or physical therapist. If a veteran’s physician decides they are “home-bound,” meaning their condition keeps them from leaving home without significant effort, then they may be eligible for home health services under Medicare hospital insurance (Part A) and medical coverage (Part B). Medicare Advantage Plans, which are offered through private insurers, provide the same types of benefits, although it is important to note that they may charge copays and have different eligibility standards.

Medicaid is yet another option to consider when it comes to affording long-term care. This federal-state government partnership program offers health coverage for those individuals who have a lower income and can help pay for long-term care services relating to nursing homes, as well as a number of home and community based care services, depending on which state a veteran lives.

We know that understanding insurance, government programs and VA health care eligibility can be complicated. Remember, we are here to help and support you. If we can answer any questions or address any concerns you may have, do not wait to contact our office to schedule a meeting.

More than 55 million Americans are currently enrolled in Medicare. The huge government health insurance program is available for seniors age 65 and older, and it consists of four main parts:

Together, Part A and B are known as “Original Medicare,” because it’s what was originally offered when the program was created under President Lyndon B. Johnson in 1965.

Medicare Advantage, or Part C, is an alternative to the mentioned offering. It allows for program enrollees to receive their Medicare benefits through a private health insurance plan. The main benefit is that approved private insurance plans may be able to offer more coverage options or more specific coverage to a certain health care need than Original Medicare.

These offerings, however, do not automatically make the program better. Medicare Advantage also comes with certain costs and coverage considerations that might not be the best fit for many seniors.

At a minimum, every Medicare Advantage plan has to include Part A and B hospital and medical coverage. While Part A is free, Part B includes an out-of-pocket monthly premium of about $134 per month in 2018 based on the senior. Medicare Advantage plans also come with premium costs, and the required Part B monthly premium still applies. This can end up being quite expensive, especially for seniors who are living on fixed incomes and can no longer work.

Moreover, some Medicare Advantage plans have high deductibles, not counting prescription drug costs. Yet another drawback is that Medicare Advantage enrollees are confined to their plan’s provider network, rather than having access to Part A and B doctors and hospitals all over the country. Supplemental coverage, such as Medigap, would provide additional coverage for items not included in a given Part C plan, but is only available for Original Medicare enrollees.

While Medicare Advantage may be great for some, it simply isn’t a good fit for others. The majority of all Medicare beneficiaries select Original Medicare, while about a third opt for Medicare Advantage. The key is to research the right plan for you based on your health needs. Medicare offers many resources to help you do this. You can learn more on the Medicare website, including using the Medicare tool to research plan benefits.

If Medicare Advantage is right for you, you can enroll during your initial seven-month enrollment period beginning three months prior to your 65th birthday month, during Medicare’s Annual Open Enrollment Period from October 15th to December 7th. Bear in mind that next year, Medicare Advantage enrollment period may be changing and you can learn more here.

Do not wait to ask us your questions on Medicare or any issue facing you as a Florida senior. We are here to support you and ensure that you have the education and information you need both now and in the future.

We understand that planning for the end of life, a disability or aging can be complicated and emotional. We are here to help you.

Contact Us