So you or a loved one has been discharged from a hospital or skilled nursing facility after receiving Medicare benefits. You may have even been told that you're no longer eligible for Medicare coverage. But did you know that if your condition worsens during 30 days after the discharge or loss of eligibility, you may be reinstated for Medicare coverage? And you may be able to move in or move back to a skilled nursing facility?
Medicare's "30-Day Window" can be confusing. Many patients of HCR ManorCare are eligible for Medicare funding, so we're developed this blog to help explain the specifics of the 30-Day rule. All to help you know your options and plan ahead for maximizing your Medicare benefits.
When do Medicare benefits apply?
A patient can continue care from a quality staff, recover in comfort and security and receive Medicare benefits under most circumstances if:
- the person has been admitted to the hospital for three consecutive days, not counting the day of discharge
- the person is transferred to a nursing center for further care of the condition that was treated in the hospital, or other conditions requiring skilled nursing or rehabilitation services
- a physician certifies the patient requires skilled or rehabilitative care after a hospital stay
If a patient is cut from Medicare, a 30-day window exists where coverage may be reinstated.
Who may be eligible for the 30-Day Window of Medicare coverage?
- Patients discharged from the hospital.
If a patient goes home from the hospital after three consecutive overnight stays*, and his or her condition worsens within 30 days, Medicare may cover admitting the patient to a skilled nursing facility.
- Patients discharged from a skilled nursing facility.
If a patient goes home from a skilled nursing facility, and his or her condition worsens within 30 days, Medicare may cover re-admitting the patient to a skilled nursing facility.
- Patients cut from Medicare at a skilled nursing facility.
If a patient is staying at a skilled nursing facility and is no longer eligible for Medicare coverage - then has a significant change in his or her condition - the patient may qualify to be reinstated to Medicare.
What does Medicare coverage pay at a skilled nursing facility?
If the Medicare 30-Day Window allows or reinstates coverage at a skilled nursing facility, the cost benefits is as follows:
|Length of Stay||You Pay||Medicare Pays|
|First 20 days||0*||100%|
|Next 80 days of continuous
|$164.50 a day**|
What is covered by Medicare?
Medicare can help pay for:
- semi-private room
- all meals, including special diets
- rehabilitation services including physical, occupational and speech therapy
- nursing care
- medications prescribed by a physician
- medical supplies
- use of items such as braces, splints and adaptive equipment
Patients must be evaluated for eligibility.
Physicians and/or the skilled nursing facility staff must evaluate patients to determine their eligibility for the Medicare 30-Day Window of coverage. Once a week for 30 days, HCR ManorCare staff evaluates the condition of our discharged patients and residents cut from Medicare to assess eligibility.
Still feeling confused about Medicare? Call a Heartland or ManorCare skilled nursing and rehabilitation center near you. Our caregivers will be happy to help you review your options and access the appropriate resources so you can take advantage of your Medicare benefits. Please feel free to contact us today for more information about services and support. Also, visit our website for more information on payment options.
* A stay beyond midnight with a hospital admission is considered an overnight stay
** Effective January 1, 2017