Yes, the rumors are true, Medicare can cover some of your skilled needs, but in what circumstance and for how long?

Medicare is a federal health insurance program primarily for individuals who are age 65 or older, or in receipt of Social Security disability benefits for more than two (2) years.  Individuals with end-stage renal failure and ALS may be able to access Medicare benefits on an expedited basis.

Medicare Part A covers the following services:

1. Hospital Care:  Medicare will cover 90 days a year for a single spell of illness, plus a 60-day lifetime reserve.  In 2022 there will be a deductible of $1,556 for each spell of illness and co-payments for days 61-90 for each spell of illness in the amount of $389 per day.  The co-payment for days 91-150 in 2022 is $778 per day.
2. Nursing Home Care: There is a 3-day hospitalization requirement for 100 days of skilled nursing coverage per spell of illness.  Days 1-20 are paid in full by Medicare; there is also a co-payment for days 21-100 in the amount of $194.50 per day (for 2022).
3. Home Health Care:  Includes nursing care, home health aides, physical and occupational therapy, medical supplies, and durable medical equipment.

Short-term home care may be covered by the Medicare Program provided that all of the following conditions are met:

• • (i) the services are ordered by and included in the plan of treatment established by the physician for the patient;
  • (ii) the services are required on an intermittent or part-time basis;
  • (iii) the services must require the skills of a registered nurse (R.N.) or the services of a licensed practical nurse (L.P.N.) or licensed vocational nurse (L.V.N.) and under the supervision of an R.N., or a home health aide.

If “skilled nursing care” is not required, Medicare will not provide coverage.

1. Hospice:  Part A covers hospice care for Medicare beneficiaries who are terminally ill and who are diagnosed as having a life expectancy of six months or less.  Most services provided by a hospice are covered, including the services of doctors and prescription drugs.  Hospice coverage is in lieu of all other Medicare benefits.  There is no deductible or co-insurance.

While these services are available, they are not always guaranteed.  In the case of Nursing Home Care, while Medicare has the potential to cover services for up to 100 days; Medicare can deny coverage in that time period if the patient is either not cooperating or their rehabilitation efforts have plateaued.

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