Navigating Medicare Coverage Gaps for Skilled Nursing Care
Learn how to help your clients avoid skilled care purgatory by understanding Medicare coverage of skilled nursing care. Explore the requirements, costs, waiver options, and home care alternatives to ensure your clients receive the necessary care without facing financial or coverage challenges.
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Presentation Transcript
Help Your Clients Avoid Skilled Care Purgatory Mitigating Medicare Coverage Gaps Chalen Jackson Key Accounts Specialist and Compliance Officer
- Medicare Coverage of Skilled Nursing - When The Clock Strikes Midnight on the Third Night - Costs of Care and Benefit Periods - For Whom the Actuarial Bell Tolls - A Friendly Spirit in your Home - It Ain t easy Using Ouija- Talking to providers - The Power of Underwriters Compels You!- Product solutions
Medicare Covers Skilled Nursing Care under limited cases - You must (in general) have spent three midnights as a hospital inpatient - Your Doctor agrees you need daily skilled care for trained staff - You need this care for a hospital related condition, or a condition that develops while receiving care for one - Must be at a Medicare Certified Facility
When the Clock Strikes Midnight- The Third Time - Impact of Waiving the Three-Midnight Rule - Who can waive the rule now - Impacts on readmission
Costs of Care can make you Pale with Fright! - In general, a beneficiary will pay nothing for the first 20 days of approved care - Days 21-100- $200 per day! - Day 101+: ALL COSTS - Importance of shopping around providers
For Whom the Actuarial Bell Tolls - To continue to receive care, you must show improvement - Or show evidence your condition would deteriorate without care - Medicare Advantage vs Original Medicare - Discharge and Readmission
A Friendly Spirit In Your Home-Home Care Options for Skilled Care - Does not cover custodial care, may cover home aide services - Requires a face to face visit before approving home care - difficulty or danger in travelling for care - $0 for home health services - 20% for part B covered equipment
It Aint easy using Ouija- Talking to Providers - The best way to protect your clients is to talk - Ask the questions they will have to ask - Find average costs, length of stay, quality ratings - Anticipate staffing issues under new guidance
The Power of Underwriters Compels You- Finding Solutions - Many short term(1 year or less) options available - Find solutions that fit around current coverage - Protect against high velocity risk - Looks for niches in Underwriting - Take a hard look at overbuying now
Resources https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled- Nursing-Facility-Care.pdf https://www.medicare.gov/coverage/home-health-services https://www.medicare.gov/media/skilled-nursing-facility- checklist.pdf
Thanks For Listening! For Questions, Please Reach out to Chalen Jackson chalen.jackson@smsteam.net 573-283-8979 www.smsteam.net
