1) You have Part A and have days left in your benefit period.
2) You have a qualifying hospital stay.
3) Your doctor has decided that you need daily nursing home care.
4) You get these skilled services in a nursing home that's certified by Medicare.
5) You need these skilled services for a medical condition that was either:
6) A hospital-related medical condition.
7) A condition that started while you were getting care in the skilled nursing facility for a hospital-related medical condition
An inpatient stay begins on the day you’re formally admitted to a hospital with a doctor’s order. That’s your first inpatient day. The day of discharge doesn’t count as an inpatient day.
For day 1-20 the total cost of the nursing home will be paid 100%.
For day 21-100 there will be a coinsurance of $167.50 per day of each benefit period (2018)
For day 101 and beyond you must pay the total cost.
Most patients who can’t afford for their care after day 101 apply for Medicaid.
If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional nursing home care. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.
If your break in skilled care lasts for at least 60 days in a row, this ends your current benefit period and renews your nursing home benefits. This means that the maximum coverage available would be up to 100 days of nursing home benefits.
MOON - Medicare Outpatient Observation Notices was passed into law on March 8, 2017. Moon law requires the hospitals to inform the patient whether they are being “observed” (outpatient) or “admitted” (inpatient) to the hospital. Most people believe that if they stay overnight at the hospital or are moved from the emergency room to a hospital room, they have been admitted to the hospital. However, this notation that you are admitted to the hospital just because you stayed overnight is wrong.
Patients must be informed of their status by the hospital within 36 hours after the observation services begins. The hospital must provide the patient or the patient’s agent a form which may either be printed or sent electronically, but the patient must then receive a physical copy of the signed acknowledgement. Hospital staff must also verbally inform patients about how Medicare may handle their observation status.
Obviously, this will assist the patient when deciding if they will continue to receive care knowing their out-of-pocket cost could rise. Medicare Part A doesn’t cover outpatient services (observation). Medicare Part B may require copays for certain outpatient hospital and physician services after the deductible. Outpatient observation services do not count toward the 3-day patient’s hospital stay for nursing home care.