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Old 12-31-2014, 11:25 PM
 
Location: Montana
1,752 posts, read 1,653,911 times
Reputation: 5951

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I was talking to my sister about my mom's long term care for dementia, and she was telling me about a quirk in hospital policy vs. Medicare transition to long term care.

In order for Medicare to reimburse for long term care, you must be hospitalized (admitted) for four (4) days or longer. Hospitals typically try to keep you for observation, rather than in an admitted status, thus eliminating transition to Medicare reimbursement if you are moved to long term care.

I believe many long term care private insurance policies have a similar caveat before they will pay benefits for long term care.

I need to research if Medicare reimburses hospitals at a higher rate for observation status than admitted status, creating a financial incentive for hospital to keep you in a status that eliminates Medicare's obligation to pay for long term care.

I will post links once I have had time to research the specifics, but FYI, always ask to be admitted to the hospital, observation status could have serious adverse impact on you finances should you need long term care.
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Old 12-31-2014, 11:34 PM
 
Location: California
4,554 posts, read 5,468,926 times
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Check some of the other Medicare threads as I think there have been other discussions about the "observation status". If I recall, it will be harder for hospitals to use this status in the future as patients are being over charged and poorly treated.
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Old 01-01-2015, 09:57 AM
 
Location: Prescott AZ
6,123 posts, read 9,076,489 times
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Medicare does not pay for long term care. You need to have a LTC policy in place for this.
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Old 01-01-2015, 10:03 AM
 
8,192 posts, read 11,908,623 times
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Quote:
Originally Posted by PhxBarb View Post
Medicare does not pay for long term care. You need to have a LTC policy in place for this.
The OP is referring to the first 90 days of LTC which Medicare does indeed cover if one is sent to a facility directly following a hospital stay. On a related matter, this is also why LTC policies usually have a 90 - day waiting period before they kick in.
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Old 01-01-2015, 10:19 AM
 
Location: Florida -
8,763 posts, read 10,837,755 times
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This "observation" and "output patient" status thing was covered in a 10/2012 AARP bulletin.

It basically said, be sure you are formally checked-into the hospital on an INPATIENT basis … in order yo cover up-to 20-days of follow-on Skilled Rehab Nursing care under Medicare. If the patient has been formally checked-into the hospital as an inpatient, Medicare pays for Rehab Care. If the patient is under observation status, the patient may be responsible for the entire cost of the Rehab. (Note: patient may be physically located in a hospital and treated like an inpatient, but, still be there “Under Observation”) – Also, note: Status can change during hospital stay and should be regularly checked (daily) ---
If a patient is classified as an “Outpatient” (Observation status) while in the hospital, their Medicare coverage is under ‘Part B’, rather than regular ‘Part A’ and may cost the patient considerably
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Old 01-01-2015, 12:36 PM
 
Location: Prescott AZ
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The stay after hospitalization is not LTC. It is considered rehab and never lasts past a few weeks. Certainly won't help in diagnosis of dementia.
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Old 01-01-2015, 12:44 PM
 
2,498 posts, read 6,390,438 times
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Quote:
Originally Posted by PhxBarb View Post
The stay after hospitalization is not LTC. It is considered rehab and never lasts past a few weeks. Certainly won't help in diagnosis of dementia.
Rehab is 18 days straight from hospital,no going home after being inpatient.
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Old 01-01-2015, 04:48 PM
 
Location: East of Seattle since 1992, originally from SF Bay Area
29,776 posts, read 54,424,430 times
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Check with her state. My mother-in-law spent 12 years in an adult family home paid for by the state medicaid program before she died last summer. We had to pay for the first few months at $3,400/month until the paperwork was done, and all of her funds and assets exhausted to qualify, and not all places take medicaid patients. In this case the place had 6 patients, but only took one at a time on medicaid because they only got $2,800, which was her social security less $50/month to keep and spend, the difference from the state. Some places charge as much as $6,000/month and we found it to be valuable to pay a social worker nurse recommended by the hospital $250 to help us find the right place for her. Long Term Care insurance should be started at about age 40, to get a good premium price and be prepared for the future, because most states have cut back on this kind of aid and it's getting harder all the time to get it.
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Old 01-01-2015, 07:08 PM
 
Location: Prescott AZ
6,123 posts, read 9,076,489 times
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We were discussing Medicare, not Medicaid. Big difference.
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Old 01-02-2015, 03:43 PM
 
Location: Montana
1,752 posts, read 1,653,911 times
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I am glad to see this is something many board members are already aware of. When my sister told me about it, I was shocked, and wanted to make sure others were warned. Sounds like most Medicare users here are already aware of this quirk.
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