Medicaid attorneys help you to create a plan to qualify for Medicare. Making sure you can qualify for Medicaid is important in case you require costly care that Medicare will not cover and that private insurance will not cover. While there are many limitations to Medicare, one of the biggest and costliest limitations is the strict rules in place regarding when Medicare will cover the costs associated with nursing home care.
Because Medicare covers nursing home care in only a very limited set of circumstances, and private policies including Medigap policies also cover nursing home care only under very limited circumstances, many people end up needing nursing home care that Medicare will not pay for. When this happens, most people are forced to pay a substantial amount of money every month out of their own pockets unless they are able to get means-tested Medicaid to pick up the tab. This is why having a Medicaid plan in place is so important. Medicaid attorneys at Mark S. Eghrari & Associates, PLLC will help with the creation of your plan.
Making a Medicaid plan is vital because Medicare has so many limitations on when nursing home care will be covered that the vast majority of people don’t get any Medicare payments for nursing homes at all. Medicare not only restricts eligibility for nursing home care to paying for skilled nursing care — rather than basic routine care — but Medicare also has a so-called two-midnight rule that limits even this type of aid.
What is the Medicare Two-Midnight Rule?
The Medicare two-midnight rule is a rule that essentially stipulates that a patient shouldn’t be admitted to the hospital on an inpatient basis unless that patient is going to have to stay in the hospital over two nights. The patient’s visit should cross two-midnights, hence the name of the rule, before the patient is to be treated as an inpatient. Because of this rule, many patients end up being admitted for observation status only. Doctors who aren’t confident that a patient will need to stay in the hospital may be reluctant to admit the patient on the basis of a possibility of an extended stay, such as in circumstances where a doctor thinks a patient might have complications after a procedure but the doctor is not sure if the patient will have complications or not. In these circumstances, a doctor who does not want to run afoul of the two midnight rule might end up just putting the patient in observation status.
According to Motley Fool, research into the impact of the two-midnight rule found around 7.4 percent of Medicare recipients who had been admitted to the hospital would likely have been admitted only under observation status or would have otherwise been treated as outpatients under the two-midnight rule. The research also revealed that the time a patient arrived to the hospital mattered, with patients who came to the hospital on weekends or late at night far more likely to end up being admitted to the hospital as inpatients compared with people who come early or on weekdays.
Not being admitted to the hospital can cause big problems for patients, both because inpatient hospital care is covered under Medicare Part A while outpatient care is covered under Part B with a larger coinsurance cost and also because a person who is treated as an outpatient typically will not be eligible for skilled nursing care. If a patient isn’t eligible for skilled nursing care through Medicare, Medicare won’t pay if that patient ends up needing to spend time in a nursing care facility or a rehabilitation facility. Medicare also won’t pay for skilled nursing care at home under most circumstances if a patient wasn’t an inpatient in a hospital.
This rule, in other words, makes it more difficult for a patient to get skilled nursing care and also makes a hospital stay more expensive for a patient. Those who are concerned about affording nursing home care or hospital care should work with Medicaid attorneys to determine if Medicaid could provide the coverage they need for healthcare and to make a plan to get Medicaid when they require it.
Getting Help from Medicaid Attorneys
Because Medicaid is means-tested, you need to make a plan to protect your assets while ensuring that Medicaid can cover the costs of care you need. Mark S. Eghrari & Associates, PLLC can help. Our Medicaid attorneys have worked closely with many clients to determine if creating a Medicaid plan is necessary and to use the right legal tools to put a plan in place.
To find out more about the Medicaid planning process, join us for a free seminar. You can also give us a call at (631) 265-0599 or contact us online at any time to get personalized help making your Medicaid plan.