MJ, 79, has a bad fall, breaks her leg and spends three days in the hospital for her injury. Although she received the same care as an inpatient, she wasn't classified as one. The hospital coded her as "Under Observation" based on guidelines set by Medicare, which means she is not eligible for rehabilitation coverage.
The term and practice "Under Observation" has been around a long time, and prior to Medicare changing the guidelines a patient would be covered and should not incur any out-of-pocket expenses. Now, that is not the case, it could literally cost them thousands of dollars, depending on their medical situation. If your doctor says something to the effect of "We're going to keep you here 'x' amount of time for observation...," simply tell them that Medicare will not cover those charges and they either need to admit you into the hospital, or you need to go to another medical facility that will.
Little did MJ know, Medicare would not cover the $28,350 claim from the nursing home for her rehabilitation after the fall.
What Can Be Done To Help Cover the Costs
Invest in a Short Term Recovery Care plan that can help pay for costly expenses due to injury or illness
- Covered Benefits include: Nursing Facility Care, Assisted Living Facility Care, Home Health Care, Adult Day Care or Hospice Care.
- Daily Benefit Options between $100-$300
- Elimination Periods of 0, 15 or 30 days
- Lifetime Maximum Benefit Period of 120, 240 or 360 days.
Applying What We Know
If a Medicare beneficiary undergoes rehab for 3 months and has enrolled in a $200 Daily Benefit for 120 days with a 0 Day Elimination Period, the Short Term Recovery Care plan would cover their claim up to $18,000. This benefit would be paid even if they are Medicare eligible for rehab coverage.
For more information about Short Term Recovery Care plans, or Medicare health plans, Final Expense plans, please contact Cruson Insurance Agency here, or call (972) 896-3851. We CAN and WILL help you!
Real-Life Story of MJ:
Independent Broker with your best interests in mind. I work for you and not one specific insurance carrier. I will find a plan that best suits your needs both medically and financially so you can make an informed decision. Contact me TODAY! I CAN help!
The Cruson Insurance Agency is your single source for all of your insurance needs. Whether you're looking for health coverage, Medicare plans, life insurance, final expense plans, temporary health coverage for new employees or in between jobs, vision, dental, hearing and even pet insurance; we can help you find the coverage that best suits your needs.