Has the Nursing Home Told You that Medicare Coverage is Ending Because the Patient is No Longer “Improving”?

December 27, 2012

Filed under: Medical Care — Alexis @ 10:46 AM

Every day, families of nursing home patients are told that Medicare coverage will be ending in a day or two, because the patient is no longer “improving.”  Well, that has never been what the Medicare regulations say, but somehow, that has become the common practice across the country.

The good folks at the Medicare Advocacy Project brought these infractions to court and won.  A federal judge in Vermont, whose order applies to the whole country, clarifies that nursing homes can no longer cut off Medicare just because a patient has “plateaued.”

Instead, the (old) new law is: so long as the patient needs skilled care, whether to improve, maintain her condition, or prevent or slow deterioration of her condition, she is entitled to Medicare payment for up to 100 days.  Period.  Looked at another way, if the patient needs skilled care on a daily basis, or if she needs physical, occupational, or speech therapy five days per week, then she is entitled to Medicare coverage for the full 100 days.

The doctor is the most important person for you to work with.  If she agrees that the patient needs daily skilled care or therapies, then a written statement from her will help you win the full 100 days of Medicare coverage.

See here for a further understanding of the end of the “improvement standard,” and then review the self-help packets.  These are straight-forward, easy to read packets that will help you explain to the nursing home administrator that the rules have changed (many of them haven’t heard yet), so that she will feel comfortable submitting the claim to Medicare and continuing the patient’s coverage.

P.S. These rules also apply to home care and outpatient therapy, as well.

Thank you, Medicare Advocacy Project!



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More Fast Track Compassionate Care Allowances Added to Social Security Disability

December 19, 2012

Filed under: Social Security — Alexis @ 3:24 PM

If you are disabled according to Social Security Disability (SSDI) regulations, and if you have worked long enough to have contributed adequately to the Social Security system, then you are entited to SSDI, and after being on SSDI for two years, you are entitled to Medicare.

Getting qualified for SSDI can be a tough process, but SSDI does have a long list of conditions or illnesses considered to be so apparently disabling, that you don’t have to go through a lengthy process to prove you can’t work.  If you have one of these conditions or illnesses, the folks at SSDI know you can’t work and they fast-track your approval.

SSDI has been hard at work lately expanding the list of fast-track disabilities.  Just recently, they added thirty-five new conditions, bringing the total fast-track list to two hundred.  The most recognizable names from the new additions are Adult Non-Hodgkin Lymphoma and Adult Onset Huntington Disease.

Check out the full list here to see if you may be able to fast track your SSDI application.

Long-Term Care Insurance Tax Deductions

December 3, 2012

Filed under: Long-Term Care Insurance — Alexis @ 3:55 PM

Thinking about long-term care insurance (LTCI)? Hesitant because it is expensive?  Did you know that you might be able to deduct some of the premium on your taxes?

If you are an itemizer, then you can take deductions as follows (2013 figures):

Attained age in tax year Limitation on premiums
Age 40 or less $360
Age 41 – 50 $680
Age 51 – 60 $1,360
Age 61 – 70 $3,640
Age 71 and older $4,550


Not an itemizer?  You still can get a break – if all of your medical expenses, including LTCI premiums, exceed 7.5% of AGI, then you can claim a deduction on the portion of your medical expenses exceeding 7.5%.

So when you are looking at a LTCI quote, keep in mind that the actual cost to you may be a bit less than the annual premium.

And of course if you already have LTCI, make sure your CPA knows that you have it and how much you pay in annual premiums.