Medicare is a government health insurance program which benefits Americans who are 65 or older or who are disabled and have worked and, through payroll deductions, paid in for 10 years, that is for 40 quarters.
Americans who have been continuously disabled since childhood can also receive Medicare benefits based on their parents’ work record if their parents applied before the adult child was 22 and, as an adult, the child has been receiving Supplemental Security Disability Insurance, based on a parent’s work record, for 24 months.
Watch the video on YouTube here: What Medicare Really Covers
Two Types of Medicare
There are two types of Medicare: original Medicare, for which you buy a Medicare Supplement, also known as “Medigap,” and Medicare Advantage. Original Medicare is more widely accepted by doctors, hospitals and nursing homes and, despite higher monthly premiums, after age 70 usually winds up being cheaper than Medicare Advantage – especially if you choose a Medicare Supplement package which covers copays and other things you will need.
Medicare Advantage plans often allow add-ons such as dental or vision coverage. Medicare Advantage plans are also allowed to experiment with various add-ons to keep people healthy. But there can be high deductibles – and there is a 20% copay. That can really add up. Most elder law attorneys recommend original Medicare with a good Medicare Supplement or “Medigap” policy.
If you go to a nursing home within a week of spending at least two nights as an inpatient in a hospital – as an inpatient, not as someone on observation status – Medicare will pay for the first 20 days in the nursing home and, with an increasing copay, for the next 80, for a total of 100 days at a time.
After 60 days without using hospital or nursing home Medicare, the count starts again.
In addition, over your lifetime Medicare will pay for an additional 60 days which you can use at any time after you have used that 100 days.
Are there other limits?
Some nursing homes seem to think so.
But Medicare does not just pay for the rehab you need to make you stronger. It also pays to help you maintain function and to prevent further functional decline.
Many people do not know this.
If you receive a Notice of Medicare Nonpayment while you still have Medicare days, appeal immediately. Call the Quality Improvement Organization at the number on the Notice of Medicare Nonpayment. Direct the nursing home and the entity handling the appeal (called a Quality Improvement Organization) to this link: https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html.
You may need to do more. You can download a checklist of transfer and discharge rules, notice requirements and more at our website www.elderlawAustin.com.
Do you know which Medicare plan is right for you? Find out more here: Which Medicare Plan is Right for Me
Estate Planning attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is active in the Texas and Austin Bar Associations. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.
She assists families of people with special needs, people planning for the retirement years and people administering estates.