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Does Medicare cover any of my skilled needs?

Does Medicare cover any of my skilled needs?

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.

When implementing an estate plan, it is important to consult with and retain experienced attorneys. The knowledgeable and compassionate attorneys at Russo Law Group, P.C., can provide professional services and advise you. We invite you to take advantage of our comprehensive website as well as our free seminars and webinars to learn more about how Russo Law Group, P.C. may assist you and provide you with peace of mind.

Deanna Eble

Russo Law Group, P.C.
100 Quentin Roosevelt Blvd., Suite 102
Garden City, NY 11530
800-680-1717

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