Medicare Assisted Living

2014 Medicare and Medigap Updates

Medicare Assisted Living

While there is no way that Medicare will shoulder extended stays in a retirement or nursing home, various provisions in the policy can provide some help for Medicare assisted living under special circumstances. In this post, we will talk about the conditions that define Medicare assisted living and how one can put this into good use by knowing the ins-and-outs of Medicare pertaining to hospitalization and recovery facilities.

In a nutshell, Medicare assisted living refers to Medicare footing the bill for a patient staying in a nursing home or skilled living facility while recovering from a specific condition. Common examples include recovery from surgery, healing from an accident, or even rehabbing a specific condition that does not require surgery but instead needs rest and relaxation as well as skilled nursing care as prescribed by the attending physician.

Of course, Medicare has serious limitations when it comes to Medicare assisted living. No patient can hope to enjoy months on end of staying in a skilled nursing facility for recovery while Medicare foots the bill. As currently constituted, Medicare policies only shoulder up to 100 days of staying in these recovery facilities as well as the medical bills, doctor fees, and medicine coverage during the period of stay. The same also applies to home health care services under Part A and Part B Medicare.

It should be emphasized that the guidelines are strict when it comes to determining the scope and eligibility for Medicare assisted living. In the case of home health services, for example, this is only given if certified by a doctor. Consequently, the services are restricted to medically-necessary part-time or occasional and intermittent health care by a skilled nurse, physical therapist, or occupational therapy as deemed important to recover from a specific illness.

Another caveat is that the patient cannot hope to have Medicare foot 100% of the bill for the services offered during the period, particularly those pertaining to the nature of the accommodation, meals, and other extraneous services that are not intrinsic to the need for recovery. In most cases, Medicare assisted living only shoulders part of the expenses leaving the patient to pay for the remaining sum.

It is in these cases where supplemental medical insurance might be helpful as these kick in whenever Medicare is not able to shoulder everything that is billed to the patient. Not surprisingly, with so many supplemental medical insurance plans available, the patient needs to take the time to select the most ideal plan long before the need for Medicare assisted living is conceived. They can then pay for the plan so when the time comes, it is available to provide extra benefits to augment Medicare.

All in all, Medicare assisted living is a pretty good way to reduce health care costs for extended time needed for recovery. Make sure to check with your contact at the health care office to know what is covered and what is left for the patient to shoulder in these circumstances so you can maximize the benefit while reducing extraneous costs in getting the services that you need and deserve.

As this article states, Medicare cannot be depended on for long term care such as assisted living or nursing home facilities. Except for the 100 days recovery period explained above retirees will need to pay for any extended care services themselves until their funds are depleted. We hope this article on Medicare assisted living has been helpful in preparing you for future health needs.