QUESTION: My mother has been in and out of hospitals for the past two years. She used her 100 days in a skilled nursing facility and now my father is paying the bill. She went back into the hospital for four days. I thought that if you were hospitalized and returned to a skilled nursing facility the 100 days started over. The financial representative at the facility told me there were more stipulations than that. Is this true?
ANSWER: The financial person at your mother’s facility was correct. The non-coverage at the facility has to do with the “benefit period” not the return to the hospital.
A benefit period begins on the day you enter the hospital or skilled nursing facility and ends 60 days after you have not received inpatient care at the hospital or skilled nursing facility.
Your mother has never ended her initial benefit period as she has not had 60 days without inpatient care. Therefore, she has used up her 100 days for the benefit period and is not entitled to another 100 days in this same benefit period.
If she were to be released from the skilled nursing facility and go without the need for inpatient care in a hospital or skilled nursing facility for 60 days then the benefit period would close.
Then if she again needed care and went to the hospital for at least three days she would open a new benefit period and be entitled to up to another 100 days of skilled care or therapy at the skilled nursing facility.
If a patient is covered by a Medicare Senior Advantage plan (an HMO or PPO) instead of traditional or original Medicare the process is different. If this is the case you should check with your particular plan to be sure of its rules and cost for such coverage.
WEDNESDAY – June 5 – 1:00 pm – Thousand Oaks Council on Aging Meeting – at Civic Arts Plaza Board Room, 2100 Thousand Oaks Boulevard in Thousand Oaks. Nancy Healy will share her memorable moments and introduce the 2019 Senior Volunteer of the Year nominees.
Friday – JUNE 14 – 5:00 PM – Summer BBQ – at Goebel Center, 1385 E. Janss Road in Thousand Oaks. Kick off the summer right – this evening includes a great dinner, live entertainment, dancing and fun, fun, fun. Tickets are $10 and currently on sale at Goebel’s front desk
TUESDAY – June 13 – 10:00 to 11:30 am – Seminar -“Navigating Placement Choices” – at Agoura Hills Recreation & Event Center, 29900 Ladyface Court in Agoura Hills. For reservations call (818) 597-7361.
Livingston Memorial Visiting Nurse Association diabetes classes, 10:30 to Noon – June 5 at Simi Valley Senior Center; 2:30 to 4:00 pm June 5 at Camarillo Community Center and 1:00 to 2:30 on June 4 at Livingston Memorial Community Room, 1996 Eastman Avenue, Suite 109 in Ventura. For information call (805) 642-0239. No registration required.
Betty Berry is a senior advocate for Senior Concerns. The advocates are located at the Goebel Adult Community Center, 1385 E. Janss Road, Thousand Oaks, CA 91362 or call (805) 495-6250 or e-mail firstname.lastname@example.org (please include your telephone number.) You are invited to submit questions on senior issues.