Do You Know What Medicare Covers and What It Doesn’t?


It’s overwhelming enough trying to figure out your own health insurance. So what if your loved one needed care? Would you know what Medicare would cover and what it wouldn’t?

Let’s say, for example, your loved one is admitted to a Medicare-certified nursing facility within 30 days of a prior hospital stay and needs skilled care, such as skilled nursing services, physical therapy, or other types of therapy. In this case, if your loved one meets all these conditions, Medicare will pay for some of the costs for up to 100 days.

There is so much data to sort through that it can be overwhelming. Our team at Always Best Care Senior Services of Central Connecticut is here to guide you through it.

Did you know that even if you stay in a hospital overnight, you might still be considered an “outpatient?” Your hospital status (whether the hospital considers you an “inpatient” or “outpatient”) affects how much you pay for hospital services (like X-rays, drugs, and lab tests) and may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay.

You’re an inpatient starting when you’re formally admitted to a hospital with a doctor’s order. The day before you’re discharged is your last inpatient day. You’re an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient. In these cases, you’re an outpatient even if you spend the night at the hospital.

Medicare may cover certain kinds of home health services like those provided by Always Best Care Senior Services of Central Connecticut– but not all.

People with Medicare are covered for home health care services if they meet all of the following
conditions:

• A doctor has both determined the need for medical care at home and outlined a plan for that care.
• They require skilled nursing care, physical therapy, speech-language therapy, or continued occupational therapy.
• They are being cared for by a Medicare-certified home health agency.
• They must be homebound. This means that leaving home is a major effort.

Medicare Parts A and B will cover home health services such as nursing care or other therapy on a part-time or intermittent basis for people who are eligible for home health services. Home health aides typically provide help with basic tasks such as bathing, using the bathroom, and dressing and are not usually covered by Medicare.

Generally, Medicare does not pay for long-term care–a term used to describe non-skilled personal care such as help with activities such as bathing, dressing, eating, getting in or out of bed, and using the bathroom.

Does that sound like some of the care your loved one needs?

We understand that all of this can be very confusing and overwhelming – especially during a trying time such as illness in a loved one. Give us a call at 860-533-9343 and we can explain everything and go over what your options are.

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