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.
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.
