Midnight Madness Medicare Style Reprise

An article that was published in the last AARP circular that we received at our house (yes, my husband and I are now both card toting members of AARP) makes me feel the need to take another pass at addressing the requirements for a hospital stay which will allow you to access your Medicare A benefits to cover any post hospital skilled nursing services that you may require.

This article highlighted a problem that I had known about at some level, but confirmed for me the significance and importance of understanding the hospitalization requirements.

In the article there were numerous accounts of Medicare patients that were unable to access their Medicare benefits to cover skilled services due to the fact that they were never officially admitted to the hospital.  These seniors were saddled with huge medical bills because they were kept at the hospital, some for more than a week, in what is called ‘accommodations’ or ‘observation’.  In other words, they were not admitted.

Now in order to access the 100 day benefit period that would cover the post hospital skilled nursing care/rehab, you must have spent 3 midnights in the hospital after being ADMITTED; being in observation or accommodations does not count toward meeting that requirement!

Last Christmas, I found myself helping with my own father’s medical emergency and hospital stay. He was admitted on the Thursday night before Christmas with the holidays looming. I was concerned about not only my father’s medical condition, but also the reality that it was unlikely that he would be able to return home again.

So, something that became very important to me (because of my knowledge of Medicare) was that I communicate with the physician in the hospital about assuring that my father was admitted for a 3 day stay (3 midnights). This would allow him to access his Medicare benefits for a post hospital skilled rehabilitation stay.

With Christmas on Sunday, there was a real possibility that the hospital would try to discharge my father on Friday or Saturday (especially given the fact that there was little that they were finding clinically). This is a common pattern in the acute care hospital setting; clearing things out before holidays and/or weekends. There is a lot of transfer activity between facilities on Fridays and the day before major holidays. If they had discharged my father on Saturday, he would have lost out on access to his 100 day Medicare benefit period.

Key Tip:

For a Medicare patient to access benefits for a skilled rehabilitation/nursing stay (in a rehab center or skilled nursing facility) they must have a 3 day qualifying hospital stay. This means 3 midnights of a ‘head in the bed’ as it is sometime referred to in the industry; 3 midnights following the date of admission.

It turns out that with the holidays my father was in the hospital until Tuesday (more than giving him the qualifying stay). He then made the transition to a skilled nursing facility where he received therapy services under his Medicare A benefits. The use of his Medicare benefits saved us >$2,000/week for the duration of his Medicare coverage! That is information worth knowing!!!

If you are a caregiver/family member of a Medicare patient, I encourage you to learn the basics related to Medicare benefits and be an educated consumer. This can help you greatly in managing the monetary resources available to the Medicare recipient. If you don’t know where to access this information, seek help and guidance from someone who can help you (feel free to give me a call!) and visit www.medicare.gov for more details!

Don’t get caught in the situation the people featured in the AARP article found themselves in.  Be aware and be an advocate for your loved one.

On the journey with you…….Kathy

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