Is Skilled Nursing Free?

 

For a while now, the government has been looking at the budget. As more people turn 65 more Medicare funds are used. Plus, as you know Medicare is available for certain individuals under 65.  If that wasn’t enough, then came the reactions to COVID.  No matter what your political beliefs are about Covid, it doesn’t presently matter. Older policy changes are being reviewed and further contained. It is important to know these changes because they will impact your out-of-pocket expenses should you need certain care.

If your agent has annually reviewed the changes in Medicare with you, then you know the current qualifications for Skilled Nursing.  Just in case, to have Medicare pay for your skilled nursing, should you need it, you need to be admitted to a hospital for at least 3 days. No problem, right? Just because you are “in” the hospital, doesn’t mean you have been admitted to the hospital.  You could be kept for “observation”. Such is the case if new medications are used, you are dehydrated, blood pressure is unstable, etc.  A licensed medical practitioner could give you better examples.  In this case, you pay for any skilled care outside of the hospital should you need it.  If you are admitted on the other hand, then Medicare will in full pay the first 20 days. That’s less than 3 weeks. If you need longer to recover, you pay a coinsurance of $185.50 per day up to day 100.  After that, you pay the full amount.  That could be up to $14840.00 depending on your stay. Would you have money to pay that in addition to your other hospital costs? Would your monthly retirement income leave room for additional  monthly payments.

Your plan covers that, right?  Regardless of whether you have a Medigap plan or a Medicare Advantage plan, if it is not medically necessary or Medicare approved your plan doesn’t cover it. Don’t believe me? Go get  out your plan and read the benefits.  Or, go on to Medicare.gov, find your plan, and then tell me what does your plan say is your part for Emergency Room Care, Outpatient care, Mental Health Services, etc. Most people miss that part because it sounds so insignificant. 

 

We also find other areas Medicare doesn’t pay for or only pays a limited amount.  The truth is most people don’t think about these costs because these events happen later in life.  If  you wait until that time, not only will it cost more, but due to health conditions at that time, you may not qualify. Then, it’s too late.  Remember, you don’t buy the car insurance after the accident, right? 

I’m glad you took a moment to stop by and listen to this podcast. Join us next time as we go over more areas, defining what they are, and what Medicare does or does not pay.