Change In Medicare Coverage Of Long Term Care

The recent settlement of a class action suit has led to an important change in what Medicare will pay for in terms of long term care.

English: Centers for Medicare and Medicaid Ser...
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Prior to the settlement, Medicare’s policy was to cover skilled nursing care only when patients were deemed likely to improve.

Now, the key criterion for coverage is a demonstrated need for skilled care even if the patient isn’t expected to improve, according to a Reuters article.

It means patients enrolled in Medicare Part A (hospitalization) who need care to maintain their current condition but who aren’t likely to improve now qualify for Medicare’s standard benefits.

However, the change has been off to a rocky start because many beneficiaries and even providers didn’t know about it.

Some people think Medicare generally pays for long-term care but the benefits are limited. Part A will cover a stay of up to 100 days in a nursing home following a hospital admission, but there is a $152 daily co-pay after 20 days. It also covers skilled home care, such as physical therapy, if a doctor certifies it is needed. It will cover 100 home visits after a hospital stay.

Medicare Part B covers home care without a prior hospitalization with no limit on visits.

If you have questions about Medicare, feel free to call us for a consultation at (626) 696-3145.

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