Does Medicare Pay For A Nursing Home?

Many are surprised to learn that Medicare does NOT pay for a nursing home in most situations. Medicaid, not Medicare is the primary payer for most Georgia nursing home care. Medicare may cover the cost of a skilled nursing facility only if  it follows a hospital inpatient stay. How can you get Medicare to cover the cost of nursing home care? nursing home

Did you know the federal government wants Georgia to repay over $100 million in federal money used to pay for nursing home admissions? How will this impact retirees who may need nursing care? How does this impact the Georgia Medicaid estate recovery program?

Long term care insurance, along with adequate life insurance and a good Medicare supplement plan form the three legs of insurance estate planning. Georgia Medicare Plans can help you compare Medicare supplement costs from over 170 different plans. Shop and compare. Instant GA Medigap rates.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices


Getting Medicare to pay for your nursing home stay

Most people just assume nursing homes are covered by Medicare.

You should never assume.

Medicare does not pay the largest part of long-term care services or personal care—such as help with bathing, or for supervision often called custodial care. Medicare will help pay for a short stay in a skilled nursing facility, for hospice care, or for home health care if you meet the following conditions:

  • You have had a recent prior hospital stay of at least three days

  • You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay

  • You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy


The 3 day rule (above) has been amplified and restated

New rules published by the Centers for Medicare & Medicaid Services (CMS) in August 2013, which became effective October 1, 2013, do NOT change the statutory requirement that a patient spend at least THREE consecutive days in a hospital as an inpatient in order to qualify for Medicare coverage of a subsequent stay in a skilled nursing facility (SNF).[1] The two-midnight standard set out in the new regulations is simply a tool for physicians to apply in making inpatient admission decisions. If a physician believes a patient will require at least two midnights in the hospital, the physician should admit the patient to inpatient status, but patients continue to need three midnights as inpatients to qualify for Medicare coverage in a SNF.


Admitted as an inpatient or for observation?

Medicare will consider paying your bill for a SNF (Skilled Nursing Facility) only if you have had 3 or more consecutive midnight’s in an acute care facility as an INPATIENT.

rosalie winkworthToo often patients are admitted to the hospital for OBSERVATION. Once their condition stabilizes they may be discharged to a nursing home for extended care. The difference in your out of pocket costs when admitted for observation vs. as an inpatient are staggering.

Consider what happened to Rosalie Winkworth during and following her hospital stay.

So when (Rosalie) spent four days in the hospital there was no reason to think that she was anything other than an inpatient. When a social worker told her that her mother was on observation status, it really didn’t register. “I thought she was being watched,” says (Rosalie’s daughter Donna Maxcy). “Observed.”

After Winkworkth’s discharge, her doctors said she needed to go to a nursing home. But since the hospital considered her an observation patient, not an inpatient, the family had to pick up the bill. – NPR

Outpatient hospitals stays, including admitted for observation, are covered under Medicare Part B. Your out of pocket cost with Medigap plan F would be $0 for the balance of Medicare approved Part B expenses.

Most of our clients have Medicare supplement plan G or N because of the greater value. In that case the patient is responsible for the Medicare Part B deductible ($147 in 2015) unless the deductible has been previously satisfied.

Our clients average saving over $500 per year in Medicare supplement plan costs. How much can you save? Click to shop and compare GA Medigap rates instantly.


Washington wants their money back

Washington called. They want their $100 million back. georgia medicaid estate recovery

Federal officials want Georgia Medicaid to return more than $100 million in payments made to nursing homes. The feds say these payments were not permitted under the program’s regulations.

The payments were made in fiscal years 2010 and 2011. – Georgia Health News

Sounds to me like DC is running out of money. Perhaps they wasted too much of OUR money and now want as much of it back as possible.

What’s good for the goose is also good for the gander. Georgia wants their money back too.

A federal judge ruled in February that Georgia should receive a refund of $90 million of Medicaid funds it mistakenly returned to the federal government, even though the state made its claim for the money after the two-year window to do so had expired.

As it stands now, Georgia is out $90 million in money they sent back to Washington but (they feel) should not have been repaid, plus DC says they owe another $100 million.

A million here, a million there, before long you are talking about a lot of money.

With all these Medicaid dollars flowing back and forth from DC to Georgia, how does this impact you and me?

For one thing you can expect Georgia to step up their Medicaid Estate Recovery Program.  Unlike Washington, we can’t print money here and our Constitution REQUIRES a balanced budget.


Medicare supplement plan cost

If you meet the requirements where Medicare will pay for your nursing home stay it’s good to know what portion is paid by Medicare and what is your responsibility.  The Medicare Coverage of Skilled Nursing Facility Care is a good place to start. Their 50 page booklet covers almost everything you need to know about Medicare and nursing homes.

Medicare supplement plans F, G and N will pay 100% of approved Medicare nursing home claims.

If you currently have plan F you are probably paying too much. You might also want to compare benefits and prices for Medicare supplement plans G and N.

Your information is never sold.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices


#MedicareNursingHome #SkilledNursingFacility #MedicareSupplementPlans #GAMedigapQuotes


Senior Care, Giving it Your Best Shot

Senior care resources. How do I find caregiving tools for seniors? Can you trust the internet? How do I find local Georgia senior care resources? How much does senior care cost? How do I compare doctors and hospitals based on quality of care? senior care

Some of us are old enough to remember Pat Benatar strutting and kicking as she belted out the lyrics to “Hit me with your best shot”. At age 27 this classically trained vocalist had already had one hit album before the song that defined Pat as a rocker that knew where she wanted to go.

But if you are responsible for the senior care of someone close, where do you go for information?

Certainly the internet is a popular choice but if you don’t know where to look, or how to evaluate and process the information you are no better off than when you started your elder care search.

Fortunately the people at Minute Women have put together a list of 50 Best Senior Caregiving Tools you can find online. On one single page you find over 50 links devoted to senior. The list is divided into 10 different sections, making it easy to find the answers you seek.

Some of the links go to government websites while others are to pages that deal with elder care issues and resources. You will also find forums at the bottom of the page that can guide you in your senior care search.

Whether you are seeking general information on topics like long term care or hospice information, or sources relevant to your needs in Georgia, we believe this is a page you should bookmark for future reference.

And here is another tip you can use.

Medicare supplement plan F is the most heavily promoted Medigap plan in Georgia. It is also overpriced in our opinion. Blue Cross recently increased prices for their Medicare supplement plans. So did a well known mutual company, but they only increased rates for EXISTING policyholders. New applicants got a discounted rate.

AARP will probably follow suit with an increase in April, which is the time of year when they typically raise rates.

At Georgia Medicare Plans we usually help our clients save $450 over their current Medigap plan with no loss in benefits. Why not shop and compare GA Medigap quotes now?

And for senior care information, check out the 50 Best Senior Caregiving Tools.


5 Medicare Myths

We talk to a lot of Georgia seniors and find there are at least 5 Medicare myths that are common and should be addressed. If you fall prey to these Medicare myths you could end up paying more for your health care than you should. It doesn’t matter how these untruths originated. The reality of Medicare is this. Medicare insurance is the most consumer friendly health care coverage you will ever experience. But if you believe the myths and misrepresentations you can pay dearly.  hospital bed



Medicare Myth #1

Because of Obamacare, Medicare beneficiaries will have fewer choices and pay more for their coverage.

This is partially true.

Obamacare cuts Medicare funding by $716 billion dollars from 2013 – 2022. The promise is that savings will be generated by eliminating waste, fraud and abuse and requiring medical providers to achieve a higher level of care.

The truth is waste, fraud and abuse will continue. As long as government programs like Medicare routinely pay for services with little or no oversight, crooks will continue to find ways to game the system in their favor.  Obamacare cuts Medicare funding

The Medicare myth is, without Obamacare the government had no way to find cheaters. Future “savings” in Medicare insurance will come through reduced payment to medical providers and cost-shifting the financial burden for care to the Medicare beneficiary.

Reduced funding for Medicare Advantage plans will result in fewer plan choices for you, higher premiums, higher deductibles, higher copay’s and fewer doctors that accept Medicare Advantage plans.

If your doctor is paid less to treat you, or is only rewarded by helping you get well, how will this impact your ability to obtain quality care?

This seems a bit of a paradox. Why shouldn’t a doctor or hospital be paid for results? Consider this.

How many Medicare patients is a doctor willing to see if they are paid 10% – 15% less than they were last year for the same treatment?

Paying for results seems fair on the surface. But think about this for a moment.

If doctors and hospitals are punished (or paid less) for poor outcomes, do you think they will “cherry pick” the easy medical conditions and let the more challenging ones slide?

Of course they will.

Look what a report about Medicare hospital readmission penalties found out.

Medicare penalties appeared to land harder on hospitals that treat large numbers of poor people, according to calculations Medicare made and included in a regulation published Friday.

Among the safety net hospitals with the most poor patients, 77 percent were penalized, while only 36 percent of the hospitals with the fewest poor patients were penalized.

Hospitals with low income patients are typically found in inner cities and rural areas. One way for hospitals to avoid the penalties is to restrict the number of low income patients that are admitted.

Which brings up another Medicare myth about hospital admission.

When is a patient admitted to the hospital?

Just ask 74 year old Rosalie Winkworth. Like many frail seniors, she tends to fall and sometimes she hurts herself. So when she spent 4 days in the hospital her daughter thought nothing of it and assumed Medicare would pay most, if not all of the bill.

But Rosalie was never admitted to the hospital. Instead she was under observation. NPR picks up her story here.

After Winkworkth’s discharge, her doctors said she needed to go to a nursing home. But since the hospital considered her an observation patient, not an inpatient, the family had to pick up the bill.

Had Rosalie been admitted to the hospital and then discharged to the nursing home, her Medicare insurance would have paid her nursing home bill. By never admitting her the hospital avoided classifying her under the readmission penalty. But that practice also meant her nursing home stay was not covered by Medicare.

Oh, and did you catch this? The Medicare hospital readmission penalty is one way Obamacare cuts Medicare funding to provide free and reduced cost health insurance to people under age 65. Over 36% of Obamacare cuts to Medicare funding comes in the form are reduced payments to hospitals.

That is not a Medicare myth. It is a fact that can impact your level of care and how much you pay for hospital or nursing home services.

Medicare Advantage plans and Georgia Medicare supplement insurance plans will not help you if you end up like Rosalie. If your bill is not an approved Medicare charge you pay.

Georgia Medicare plans can show you ways to hang on to more of your savings and reduce stress over your budget. We specialize in Medicare supplement plans for seniors 65 and up. Most of our clients average saving over $700 per year by learning how to choose the right Medigap plan for their needs. Our GA Medigap Quotes page allows you to shop and compare up to 40 plans in 60 seconds. Why not try it now and see how much you can save?


Medicare Myth #2

Medicare Advantage plans are better than Medicare supplement plans.

Or the inverse, Medicare supplement plans are better than Medicare Advantage.

The truth of the matter is, each approach has benefits and “bugs” that appeal to some and not others. The only truth is, the plan that is right for you is the one that fits your needs and budget.

Medicare Advantage plans have lower premiums and are good for people that can budget for medical emergencies or have a pile of money sitting around collecting dust. In other words, they are good plans until you get sick.

Medicare supplement plans allow you to stay in the original Medicare system and make it possible for you to survive a medical emergency without hocking the farm.

Most Medicare Advantage plans give you a list of participating doctors and hospitals and tell you to choose from that list. A list that changes every year.

With original Medicare and a Medigap plan you can use any doctor, hospital or lab anywhere in the country, including your own back yard. If you like your doctor you can keep your doctor.

When you have a Medicare Advantage plan your monthly premium is less than with a Medicare supplement plan but that does not mean the cost is lower. The myth that you save money with an Advantage plan is just that. A myth. You simply pay for your health care now (with a Medigap plan) or later (when you have an Advantage plan).

Shop and compare GA Medigap quotes now.

Your information is NEVER sold


Navigating the Medicare Maze


Medicare Myth #3.

All doctors take Blue Cross.

BCBSGA is a fine company that offers a choice of Medigap or Medicare Advantage. The myth that all doctors take Blue Cross can get you in a bind.

Most Georgia doctors do not participate in ANY Medicare Advantage plan and the ones that do may not participate in your BCBSGA  Advantage plan. If you use them any way your out of pocket cost for treatment will be higher than if you had used a participating provider. In some cases, treatment by a non-par provider means your claim is not covered at all.

You won’t have that issue with original Medicare and a Medigap plan. Any doctor that treats Medicare patients will also treat you, regardless of which Medigap carrier issued your policy. BCBSGA only offers 3 supplement plans in Georgia. You can pick plan A, F or N.

Of those, F is the only popular choice (and N is a distant third). If you bought plan F from Blue Cross you might pay as much as $500 more per year for the exact same coverage had you picked a more reasonably priced carrier.

The Medicare myth that Blue Cross is more widely accepted by Georgia doctors could cost you a lot of money. Compare our rates vs. Blue Cross and see for yourself. Shop GA Medigap Quotes now.


Medicare Myth #4

Medicare supplement plans from “brand name” carriers cost more because they are better.

Medigap plans are designed by CMS, not by the carrier. CMS requires all plans with the same letter (for example, F) to be identical in every way. Plan F from Blue Cross is identical in every way to plan F from Aetna, Equitable or New Era.

Except price.

When you pay more for a Medigap plan you don’t get more, you simply paid too much. Who wants to do that?


Medicare Myth #5

All Medicare insurance plans with the same letter are identical, so just buy the one with the lowest premium.

This is where having someone who knows the Medicare landscape can help you avoid the pitfalls of buying the wrong plan from the wrong Medicare insurance carrier.

In 2010 Medicare allowed carriers to offer Medicare supplement plan N for the first time. Some carriers jumped in while others did not. One of the carriers that aggressively marketed plan N was Mutual of Omaha. Had you bought a Mutual of Omaha plan N policy in 2010 you got a good deal.

But only until your next renewal.

Mutual of Omaha stopped selling plan N in 2011 as losses on that block started to get out of hand. Those who kept their policies have faced ever increasing renewal premiums. In some cases their only choice was to drop their Medicare insurance policy and go without coverage (other than original Medicare).

More recently AFLAC entered the Georgia Medigap market in 2012. A little over a year later they dropped out. Their policy holders are watching their premiums continue to rise as that block of business sours.

The Medicare myth of buying the lowest price backfired. My 38 years in the health insurance industry has taught me how to avoid the pitfalls of jumping on the latest fad. That helps my clients to save thousands of dollars over the years by finding value without jeopardizing your bank account when things don’t work out.

So what about the dog?

I thought he was cute. Maybe when you shop for Medicare insurance you will remember him and give me a call to discuss your options. Don’t throw away money because you believed a Medicare myth.


#GAMedigapQuotes #AetnaMedicareSupplement #NewEraMedigapQuotes #NavigatingThe MedicareMaze

Medicare Patients Face Bigger Hospital Bills

Medicare patientsMany Medicare patients may find themselves paying more for their care following a hospital stay. A LOT more. If your hospital admission qualifies under Medicare rules, you are entitled to up to 20 days convalescent care that is covered by Medicare.

But some Medicare patients are short changed due to the way their hospital stay is coded. They can still go to a nursing home, but may have to pay hundreds or thousands of dollars up front.

A patient could be treated at a hospital for congestive heart failure for four days then, because the stay didn’t count as an admission, owe $250 a day for follow-up nursing home care.

Post Gazette


Medicare patients need to know the rules if they want to hang on to their money. The federal government is trying to balance their budget on the backs of seniors.

What has changed is Medicare’s interpretation of what constitutes an inpatient hospitalization — and several days in a hospital bed receiving treatment under a doctor’s care does not necessarily meet the criteria.

Medicare changed the rules, but did you get the memo?

No, because there wasn’t one. In most cases you discover the rule change when you get a huge bill from the nursing

Historically, an outpatient observation would be a period of time when a person is being evaluated for something like chest pain or is receiving short-term treatment while doctors decide if further, inpatient care is needed.

But, in an attempt to hold down costs, the scope of “observations” now can include spine fractures or overnight stays that last several days while the patient undergoes tests and receives treatment.

The definition of observation changed. If your stay was less than 24 hours it would have been classified as observation, not an inpatient admission. But now you can stay several days without technically being admitted.

With Medicaid, which provides coverage for low-income families, observations are not reimbursed at all.

Now Medicare patients and those with private insurance are paying the price, too. Under Medicare rules, a beneficiary is entitled to a nursing home stay following a minimum three-day hospitalization. But it must be a three-day admission — and neither time spent in the emergency room nor the day of discharge count.

In other words, someone can be receiving hospital treatment for congestive heart failure over four days but Medicare may consider it an observation. Then, when the patient transfers to a nursing home afterward, there’s no coverage — and the facility may start charging $250 a day or more.

So now you know.

If you are a Medicare patient in a hospital, know the rules unless you want to pay dearly.

If Medicare denies your claim, your Medicare supplement plan won’t pay either. Something to keep in mind.

Georgia Medicare Plans have the best Medigap rates in Georgia. Check us out for yourself.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices


#Medicare  #observation

Convalescent Care and Nursing Homes

Convalescent care and nursing homes in Georgia presents a challenge.

Which nursing home is best for my loved one?

Where should I get my surgery?

Consumers often have no clue on choosing a health care facility for themselves or a loved one.

Sometimes they’re guided by a physician. But having more data about the quality of care at a hospital or nursing home can allow a person to choose more confidently.

The federal agency that runs Medicare and Medicaid has updated two websites that allow consumers to check out facilities near their homes.

The two sites, Hospital Compare and Nursing Home Compare, provide data on quality measures, such as the frequency of infections, how often patients have to be readmitted to the hospital, and the percentage of nursing home residents who report having moderate to severe pain.

Updates to Nursing Home Compare include the actual narrative text of nursing home deficiency reports, and figures that report a nursing home’s use of antipsychotic medications.

The Boston Globe published a series examining overuse of antipsychotic drugs to sedate elderly nursing home residents, many of whom suffer from dementia and are at risk of serious, sometimes fatal, complications when given these powerful medications.

Additions to Hospital Compare include new figures that cover the potential health risks of imaging services, such as exposure to unnecessary radiation.

The sites can be found online at and

Medicare only covers skilled care. To receive Medicare benefits for a nursing home stay you must be admitted to a hospital for 3 days (not including your day of discharge), you must be admitted to a nursing home within 30 days of discharge, and you must received skilled nursing care for the condition that caused your hospital admission.

Medicare coverage for a nursing home stay is limited to 100 days and you are required to pay a copay for 80 of those days.

A Convalescent Care insurance policy may help defray some or all of the expenses. Ask us about how a Convalescent Care policy can help.