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2003 Non Hospital Medicare Benefits
Site Administration

A Primer About Non-Hospital Medicare Benefits – 2003

Who is eligible and what is paid


To Be Eligible For Medicare Benefits In A Skilled Nursing Facility

1. You must have been an in-patient in a hospital for at least three consecutive days excluding the day of discharge; and

2. Your doctor must specify that skilled nursing care is needed on a daily basis; and

3. Your care in the skilled nursing home must be due to one or more of the conditions for which you were treated in the hospital; and

4. Your care must be provided in a Medicare-certified skilled nursing facility; and

5. Since your coverage for skilled nursing facility days is available under Medicare Part A, your coverage limits may not have been exhausted.


If You Are Eligible, Medicare Will Pay The Following for Skilled Nursing Care

1. Medicare will pay the entire cost of care during the first 20 days of your stay.

2. Medicare will pay the entire cost of care for the next 80 days of your stay EXCEPT FOR $105.00 per day that either you will pay or will be paid by your Medicare Supplement Insurance Policy. After 100 days, you pays the entire cost.

IT IS IMPORTANT TO REMEMBER THAT MEDICARE DOES NOT COVER CUSTODIAL CARE – ONLY SKILLED CARE. SINCE MOST PEOPLE RECEIVE INTERMEDIATE CARE OR VERY LITTLE SKILLED CARE, MEDICARE IS NOT A LARGE PAY SOURCE FOR NURSING HOME CARE. IT IS UNUSUAL FOR A MEDICARE BENEFICIARY TO RECEIVE MEDICARE BENEFITS FOR 100 DAYS OF CARE AS MOST RECEIVE TWO WEEKS OR LESS.


To Be Eligible For Medicare Home Health Care:


1. You must be confined to your home; and


2. You must require part-time or intermittent skilled nursing services, but not 24-hour per day skilled care.

3. You must be under a doctor’s care.

4. You must receive care from or through arrangements made by a participating (Medicare-certified) Home Health Agency.

5. The services provided to you must be provided pursuant to a treatment plan created and reviewed periodically by a doctor.


If You Are Eligible, Medicare Will Pay The Following Benefits for Home Health Care:

1. The entire cost for eligible Home Care services

2. An amount equal to 80% of eligible durable medical equipment and you are responsible for 20%.


NOTE: THE DOCTOR MUST BE ABLE TO CERTIFIY THAT YOUR HEALTH IS IMPROVING BASED ON THE CARE RECEIVED IN ORDER FOR MEDICARE COVERAGE TO CONTINUE.

NextSteps® 2003



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