Medicare Coverage

Medicare only provides coverage for unskilled care when it is part of a skilled care treatment plan. Case managers must be familiar with the levels of care for their clients. Medicare provides coverage for SNFs or nursing homes when assessed as medically necessary and follows within thirty days of a three-day hospitalization. The Medicare benefit period covers 100 days of skilled nursing, during which the patient is responsible for copays for days 21 through the duration of the covered period. Medicare coverage of home health services requires that the patient be homebound and need intermittent skilled services (such as nursing or respiratory). Bathroom equipment is not covered, and equipment that is covered requires a copay.

Individuals diagnosed with terminal illnesses have the option of Medicare coverage of hospice care, which includes: pain relief, physical therapy, nursing and supportive services, and symptom management. The patient may need to pay up to a $5 copay for medication, and 5% of the Medicare-approved amount for inpatient respite care may be required.