What is the point of Medicare?

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and why do patients need to stay a certain number of days in the hospital to get it?

Are most people in nursing homes on medicare?

Sun0408, ASN, RN

1,761 Posts

Specializes in Trauma Surgical ICU. Has 4 years experience.

Medicare is for the elderly or disabled.. They do not need to stay so many days to get it. Medicare will only pay for so many days per DX and they do have a preset number for each DX.. Of course that is ideal but doesn't always work.. I am not sure if medicare will cover long term care in a nursing home, I do know they will do a short stay for rehab..

chiuli

62 Posts

What kind of financial aid do elders get in nursing homes

And, if the person outstays the set number of days they get per diagnoses, what happens next?

Sun0408, ASN, RN

1,761 Posts

Specializes in Trauma Surgical ICU. Has 4 years experience.

I know alot are on state insurance.. They lose their home, assets etc to cover the cost.. Others have private insurance that pays for long term care, families pay for it out of pocket etc.. It just varies from state to state and family to family.. As far a medicare paying past the allotted number days, yes they still pay.. How it all works out in the end IDK.. Illness are complicated and so are people, it really varies. It is just an average tho, its not written in stone. Hopefully someone will write in that knows more about it..

NotFlo

349 Posts

and why do patients need to stay a certain number of days in the hospital to get it?

Are most people in nursing homes on medicare?

It sounds like you are confusing a couple different medicare rules.

First of all, Medicare is a federal program to provide medical insurance in the US to the elderly. Citizens over 65 who worked enough (or whose spose worked enough) to qualify for social security should automatically qualify for some type of medicare.

In order for medicare to pick up a rehab stay, a person has to have a qualifying hospital stay of three days.

The usual time medicare will cover at a rehab/nursing home in a lifetime is 100 days.

If this runs out and the person still can't go home the facility will usually work with the person to get them on medicaid. MEDICAID is a state run program and people qualify for it by being low income. Medicaid has limits on how much money and property a person can own and they will sieze properties and bank accounts to cover someone's nursing home stay.

Almost all long term patients in nursing homes are on medicaid. You have a few self-pay or people with long term care insurance but most are medicaid.

Sometimes people come to my rehab, their insurance cuts them off of their medicare runs out, and they don't qualify for medicaid and they can't take care of themselves at home...then they start accuring enormous bills every day they stay in the rehab, bills they can't pay. Then it can get messy...

chiuli

62 Posts

So when you become elderly and you're not working anymore, what happens to your insurance?

KateRN1

1,191 Posts

Specializes in COS-C, Risk Management. Has 20 years experience.

Generally your employer-provided insurance goes away. Many Medicare recipients pay out of pocket for a Medicare supplement that covers part of the costs that Medicare doesn't pay as well as for the drug benefit.

When patients run out of time at the rehab, they are often discharged to home with home health care, regardless of whether they are good candidates. Traditional Medicare does not have a limit on the number of days that a patient can have home health care, although they do need to meet the criteria (homebound, need for skilled service, under the care of a physician). Medicare Advantage plans may limit the number of days/visits that patients are eligible for home care. They cannot be admitted for Medicare-paid care unless they need the intermittent services of an RN, Physical Therapist, or Speech Therapist. Patients who needs assistance with ADLs and IADLs only (bathing, shopping, cooking, med admin, etc) do not meet the criteria.

Patients who land in nursing homes for long-term care generally have to spend out of their resources (home, property, vehicles) if they do not have long-term care insurance or family to pay the overwhelming cost.

SimonJester

88 Posts

These are all good reasons if you can afford it you should get long term care insurance when you are 60 years old. LTC care can run 30k to 50K a year, as you can see you could run through your retirement quickly.

Statically the most expensive year of your life will be your last year...

nurse0520

60 Posts

Has 1 years experience.

i used to work for a health insurance company before they layed me off and went back to school for nursing so, medicare will pay for nursing homes but they ususally have a supplement insurance to cover the rest or have medical assitance for the poor or self pay, sometimes it is for only a short time depending on the dx, sometimes it is long care though. i hope this helps medicare is a very complicated system it is still confusing for people who work there i have had to cal a medicare hotline for a claim i recevied once and they did not know why they paid what they paid :lol2::lol2:

Specializes in LTC, Hospice, Case Management. Has 37 years experience.
The usual time medicare will cover at a rehab/nursing home in a lifetime is 100 days.

It is NOT for a lifetime.

John Doe age 65 w/ medicare breaks a hip..goes to hospital for 3 days (actually 3 midnights)..goes to nursing home and receives daily skilled care and therapy for up to 100 days (must continue to show progress with goals or else is cut prior to 100 days). John gets all better and goes home. Sometime after he has been out of the nsg home for 60 days he falls and breaks the other hip. At that point the cycle can begin again.

The key is a 60 day break in the spell of illness to receive more medicare benefits in a nursing home.

Now lets say John broke his second hip 50 days after being discharged from nursing home..he then has to pay all fees privately or qualify for medicaid.

Medicare = federally funded program for people over 65 with enough work credits (or a spouse of a person with enough credits) or for someone younger that has qualified for permanent disability.

Medicaid = State funded program for poor people. From reading this forum for several years, I gather that all state programs for medicaid work differently.

grannyrn65

102 Posts

It sounds like you are confusing a couple different medicare rules.

First of all, Medicare is a federal program to provide medical insurance in the US to the elderly. Citizens over 65 who worked enough (or whose spose worked enough) to qualify for social security should automatically qualify for some type of medicare. If you are under sixty-five and disabled, you must receive SSDI for two years before you become eligible to opt into Medicare. If you do, you will be charge the full fee by Medicare. The fee varies on whatever or not you choose Part A or B or both. This past year, I had $98 a month with held as my payment. I had to pay an additional $102 a month for supplementary insurance. I would like to point out that both these fees went up in January, 2010. And one is going up in 2011. And I did not get a cost of living increase in 2010 nor will I receive one in 2011.

In order for medicare to pick up a rehab stay, a person has to have a qualifying hospital stay of three days.

Anyone on Medicare must have a legiment three day inpatient hospital stay to be eligible for SLN or Rehab.

The usual time medicare will cover at a rehab/nursing home in a lifetime is 100 days.

Medicare covers an initial stay of twenty-one days, with a co-pay from either Medicare or one's supplementary insurance. Stay beyond that initial period you opt into your 100 lifetime benefit.

If this runs out and the person still can't go home the facility will usually work with the person to get them on medicaid. MEDICAID is a state run program and people qualify for it by being low income. Medicaid has limits on how much money and property a person can own and they will sieze properties and bank accounts to cover someone's nursing home stay.

Depending on the state you live in, depends on your eligibility. I live in Florida. To be Medicaid eligible, I can not have a monthly income of more then just under $400. If I were married, the limit increase. If married and owing a home, my spouse can continue to live in it until they die. Then the state gets it and any life insurance policy. The nursing home gets all of my social security with the exception of $30 a month.

Almost all long term patients in nursing homes are on medicaid. You have a few self-pay or people with long term care insurance but most are medicaid.

Sometimes people come to my rehab, their insurance cuts them off of their medicare runs out, and they don't qualify for medicaid and they can't take care of themselves at home...then they start accuring enormous bills every day they stay in the rehab, bills they can't pay. Then it can get messy...

Home Health is limited to 35 hours a week. This includes everyone, aide, nurse, PT, OT. Yes, Medicare is a big drain on the younger working population. But it was a big drain on me when I was working. I've been employed since 1967 and paid FICCA all those years. And yes, the greatest amount of Medicare is paid on end of life care. And yes, families generally refuse to let their parent die. But with the changes coming, in health care, have hope. Congress will start limiting our coverage because someone will finally put the brakes on. The far Right wasn't too far off with their granny death panels.

Cheers:yeah:

GrannyRN65