Question

what long- term care services do Medicare cover? What restrictions are placed on them?

Answer 1

Medicare ( Coverage and Restrictions)

1. It provides health care for 65yrs and older
2. For patients under 65 who receives Social Security Disability Benefits
3. People of all ages diagnosed with End stage renal disease ( Permanent kidney failure who requires kidney transplant or dialysis), Amyotropic Lateral Sclerosis ( ALS)
4. It covers acute care such as doctor visits, drugs and hospital stays
5. It pays Skilled Nursing facility with following conditions
6. Hospital admission with inpatient stay for 3 days
7. Admitted in Medicare-certified nursing facility within 30 days of that inpatient stay
8. If you require skilled care such as skilled nursing services, physical therapy or other types of therapy
9. After you met all this criterias, Original Medicare will pay upto 100 days as follows
10. 1) 100 percent of the cost paid for first 20 days
11. 2) From 21 st day to 100, you have to pay daily Copayment, which is about $164.50 as of November 2017, and Medicare pays any balance
12. After 100 days it will not cover anything in Skilled Nursing Facility
13. Medical Conditions
14. When a doctor prescribes as injury or illness who needs care, Medicare cover for the following areas
15. Skilled Nursing Care ( Part time or Intermittent)
16. Medicare Certified home health agency (which provides Physical therapy, Occupational therapy and Speech Language Pathology)
17. Medical Social Services ( To overcome Social, Psychological, Cultural and Medical Issues that caused by illness.). It also includes accessing services and follow-up care, Teaching how to use health care and other resources, and explaining your diseases
18. Medical Supplies and durable Medical Equipment- It includes Wheel Chairs, Hospital Beds, Walkers and Oxygen. For Durable Medical equipment, Medicare pays 80 percent and rest 20 percent you have to pay
19. NB- For these services, as long as it is necessary, there is no limitations, with doctors reorders in every 60 days. No requirements of good prognosis and expecation of improvement from the current disease condition.
20. In some Cases Medicare covers ongoing long term care services. This is to prevent further decline for people with medical conditions that may not improve, such as ALS, Alzheimers disease, Multiple sclerosis, Parkinsons disease and Stroke
21. Hospice Care- Medicare Covers terminal illness. But, You are not expected to live more than 6 months. During Hospice care, it pays for medical and support services from a Medicare approved hospice provider, Drugs to control Pain and Symptoms of illness, and limited Respite Care. It does not cover Grief Counselling. The patient can receive hospice care at his/her home, Hospice care Facility, and Nursing Home. Medicare also cover Inpatient Care and some short term hospital stays.
22. But It does not cover Custodial Care such as assistance with Eating, Bathing and Dressing
23. It does not cover Assisted living and Adult Care
24. It does not cover patients who are living in Nursing homes indefinitely, due to disability and inefficiency to take care themselves