Shattering the Myths of Medicare


What Medicare really pays……


Nursing Home Coverage:

Medicare only pays if an individual goes from a full 3 day hospital stay, directly to a facility requiring skilled care. Medicare will then pay the first 20 days at 100%. Days 21-100 are paid after the Medicare deductible. The deductible for 2001 is $99 dollars a day. After day 100, an individual is responsible for the expenses 100%. Tax Qualified policies can't pay the Medicare deductible (according to HIPAA regulations), but some Non-TQ policies will.

Home Health Care Services:

Medicare pays 100% of home health care services if an individual qualifies. The criteria is listed below:

1) Care must be approved by a Medicare approved HHC agency.

2) An individual must qualify for care every 60 days via an updated plans of treatment.

3) Services will only be paid while the individual is showing signs of improvement. Once physical improvement stops, Medicare stops paying.

4) Medicare only pays for post hospital acute care in the home.

5) Cognitive Impairment is not covered.

6) Medicare only pays when skilled services are required by an RN.

Please think twice before buying a 90 elimination period on a Long Term Care because you think Medicare is going to pay. Individuals only qualify for Medicare payments for the nursing home stays 5% of the time. Please contact us at  American Retired Persons Association if you have any questions at all.


Medicare Return
Medicare Return