Short Term Skilled Nursing Care Dilemma

Retirement, Income, Tax & Estate Planning.

Short Term Skilled Nursing Care Dilemma

April 4, 2014 Health Care Long Term Care Medicare Newsletter Retirement Planning Uncategorized 0

~ Admitted vs. Observation ~

A recurring, expensive and very frustrating problem in the world of Medicare is the cost of skilled rehab after a hospital stay. What Medicare pays for is determined by how you are classified during your Hospital stay… “Admitted “or “Observation”

Click here for a recent and very good article from the Phila. Inquirer with a focus on Abington Hospital. It is the story of a woman who got caught up in the “admitted vs. observed” mess.

Medicare will pay for 20 days of skilled convalescent care but only if you are in the hospital for 3 full days (72 hours) not including the discharge day. A Medicare Supplement will pay for another 80 days. On the face of this description, all seems fair and reasonable.

However…The 3 days of a hospital stay MUST be under “ADMITTED” status not “OBSERVATION” status. As a patient (or family member) you may not know you are in the hospital under observation status because the care is essentially the same.

Medicare pays less for Observation status than Admitted status, and the Medicare rules are so  severe that if a Hospital ‘admits” a Medicare patient rather than have them under ‘observation” and Medicare challenges it and wins the challenge, Medicare pays zero($0) for the entire hospital  stay no matter how costly it was. So the hospitals always attempt to proceed with caution and Observation Status is used often.

Keeping more folks under ‘Observation’ eliminates the possibility of Medicare having to pay for Rehab and the patients then would have to pay 100% of the Rehab bill. (Which is usually at least several hundred dollars per day!)

The solution is having private insurance…either Long Term Care or Short Term Care Insurance.

This private insurance will allow you to rest easy and not have to worry about getting caught up in the “Admitted vs. Observed” mess because you have your own private insurance that you can use as needed and not fret about complex Medicare Rules and Regulations!

I or Matt Sussman (who is an associate of Franklin Retirement Solutions) can help with these products. I sell a product called Short Term Care Insurance which provides some basic coverage but not as comprehensive as Long Term Care Insurance. Matt is the Long Term Care Specialist. Both products cover Facility Care and Home Care. (Medicare does not pay for non-skilled Home Care)

Call us if you would like details and price quotes for Short Term or Long Term Care Insurance

Until next time…

Howard Peck


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