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The Medicare Loophole

Many of us are under the false impression that Medicare is there to cover long term care services. This could not be farther from the truth! Medicare does not cover long term care, in fact, it was designed to help cover “short term” rehabilitation and medical services. Medicare does help to cover some limited skilled nursing care and some limited home health care with restrictive short term conditions. 

This short term care is typically limited to 100 days, but only as long as you meet the following requirements:

This care can be provided to you after a minimum 3 day stay at the hospital prior to entering the nursing facility. This in turn eliminates most cases for Alzheimer’s and Parkinson’s cases.

When you enter the nursing facility, it must be for the same reason you were seen in the hospital and it has to fall within thirty days of your hospital discharge.

As long as you are improving each day with care, Medicare will cover you but once you level off and stop improving, Medicare stops all payments for care coverage. To reiterate, this care will only last up to 100 days through Medicare so once those 100 days are up and you continue to need care, then you will begin paying out of pocket. Last thing to note is that Medicare only covers Skilled Nursing care so if you require any Intermediate or Custodial care, you will be required to pay for that out of pocket. 

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