A lot of health care providers still don’t know that the law has changed, and that Medicare now covers many skilled nursing, home health care and therapy services even if they simply maintain a person’s health and don’t improve their condition.
Although the government launched an educational campaign about the change earlier this year, a large number of providers are still in the dark and are refusing to provide treatment on the grounds that Medicare won’t cover it, according to a report by the Center for Medicare Advocacy.
The change is very important for seniors who suffer from diabetes, heart disease, Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, Lou Gehrig’s disease, arthritis, or the effects of a stroke, among other conditions.
For decades, Medicare had a “rule of thumb” that coverage of skilled nursing, home health care and outpatient therapy services was available only if they were likely to improve the patient’s condition. Other treatments were considered “custodial care” and ineligible for coverage. But thanks to a class action lawsuit, that has now changed.
Seniors who are enrolled in Part A, which covers hospitalizations, are eligible for up to 100 days in a skilled nursing facility (as long as it follows a three-day hospitalization), as well as up to 100 home visits following a hospitalization. Seniors who are enrolled in Part B, which covers doctor visits and other outpatient services, are eligible for potentially unlimited home visits.
Further, anyone who applied for Medicare benefits after January 18, 2011 and was denied due to the “rule of thumb” can now have that denial reviewed.
We’d be happy to help you if you believe that you were denied coverage or treatment incorrectly under the new rules.