Sikov and Love, P.A.
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Medicare Coverage and Long Term Care Planning

Long term care planning may start with a discussion of what Medicare covers when it comes to nursing home care.  Usually, Medicare pays for up to 100 days of skilled nursing home care which is restorative in nature and which follows a 3-day hospital stay to a Medicare-approved facility within 30 days of discharge from a hospital. 

However, many individuals now remain a hospital for several days on "observation status," so that they are not admitted to the hospital. If they are not admitted, they cannot meet the Medicare requirement for a 3-day hospital admission.  Being kept on observation status means that if they are admitted to a skilled nursing facility, they cannot be covered by Medicare and would have to pay for the care out of their own pockets or apply for Medicaid or Medical Assistance eligibility. 

When engaging in long term care planning with an elder law attorney, it can be helpful to discuss this Medicare coverage issue while determining how payment will be made for long term care.

The federal government is currently working on legislation to help fix this problem, which would help to ensure that individuals would be notified in a timely fashion if they are on "observation status" and are not admitted to the hospital.  This timely notice would permit them to work with their doctors to be sure they are admitted if it appears that skilled nursing home for physical therapy, occupational therapy, intravenous medication or something similar, will be needed. 

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