Medicare Coverage And The Law
The most important things to know about Medicare long term care coverage are the limitations, based on the plans you have selected. Typically, Medicare Plan A covers the first 20 days of hospitalization and long-term care/rehabilitation, so long as it is first triggered by a three-night stay in a hospital. Please note that the hospital stay must also be as an admitted patient, NOT just “under observation.”
After the first 20 days, depending on the plan you have, Medicare will cover an additional 80 days, subject to a co-pay, so long as the medical professionals involved believe the patient can continue to benefit from the care provided. There is no longer a requirement for the patient’s “continued improvement” in order to continue Medicare’s coverage during that time period.
If, however, medical providers determine an individual is no longer eligible to receive Medicare coverage sooner than 100 days, they must provide written notice three days prior to terminating said coverage. At that point in time, the individual may appeal the finding, may private pay, and/or may apply for Medicaid coverage.