Medicare guidelines can be very complicated and we will be glad to discuss these issues with you.

Q:"What is Medicare?"
A: Medicare is a federal health insurance program primarily designed for individuals who are age 65 and older and are entitled to Social Security benefits. Other individuals are entitled to Medicare due to Railroad Retirement benefits. Younger individuals can also qualify for Medicare, such as those receiving Social Security or Railroad Retirement disability benefits .

Q:"I thought I had 100 days!"
A: It is rare, but possible, to use 100 days of Medicare. You must meet certain criteria. The usual requirements are:

1.  You are on a tube feeding.

2.  You have a medical condition, such as deep bedsores, which take 100 days or more to heal.

Q:"Does Medicare pay the full daily rate while in a Skilled Nursing Facility (such as a Transitional Care Unit)?"
A: If you are still meeting Medicare part A qualifications Medicare pays:
Days 1 - 20: the full daily rate
Days 21 - 100: a portion of the daily rate; you pay a co-payment
Medicare pays the full daily rate for the first 20 days in a skilled nursing facility if you are still meeting Medicare Part A qualifications. On the twenty-first day of your stay in a Medicare certified skilled nursing facility you will be required to pay a co-payment. Your co-payment may be paid by your supplemental insurance or may be out of pocket. This amount changes every year. Medicare adds your days from facility to facility in one benefit period. For example, if you were in the hospital’s skilled nursing facility for 20 days and moved to a skilled nursing facility in a nursing home the following day, Medicare would consider the next day as Day 21. Please contact the Admissions Coordinator or Bookkeeper to determine the amount of co-pay during your stay.

Q:"How long will I be on Medicare?"
A: For most patients at the Foss Home, a continuation of Medicare coverage is allowed for the following:

1.  Occupational, Physical and Speech Therapy as long as you are learning new techniques and making functional progress.

2.  Management of severe, debilitating pain

3.  Management of severe illness

4.  Monitoring of important medication changes, usually accompanied by unstable illness.

5.  Wound care for very deep wounds and/or complicated with infection or poor circulation.

6.  Intravenous medication

Q:"How do you decide to take me off Medicare?"
A: A review committee meets weekly to assess your progress. We compare your case to the Medicare guidelines. Please feel free to call us at any time to ask about your Medicare time. The following are examples of why your Medicare Part A benefit may end:

1.  Repeated refusal of therapy without medical justification.

2.  You have reached a plateau with therapy, or there is nothing new for therapy to teach you.

3.  You are stable medically. For example, your emphysema is under control with the use of oxygen, inhalers and reduced activity level.

4.  Medication therapy (i.e., antibiotics) is complete.
   

Q:"I’m not ready to go home -- why can’t I stay on Medicare until I’m all better?"
A: You may be surprised to know some of the things Medicare will NOT cover:

1.  Therapy that is the same every day -- no new skills to learn.

2.  Prolonged medication adjustments, for example, tapering prednisone over a few weeks, or increasing the dose of an antidepressant over a few weeks.

3.  Endurance building.

4.  Waiting for bone healing in fractures, even when further therapy is not possible until bone is healed. In some cases, Medicare coverage can be re-started after a period of non-coverage during bone healing.