How Medicare’s Two-Midnight Rule Makes Getting Nursing Home Care Difficult

An Overland Park Medicaid planning attorney will ensure that you have a plan in place to pay for nursing home care if you must move into a nursing home on a temporary or permanent basis because of illness or an age-related infirmity. Unfortunately, getting the costs of nursing home care paid for is a major concern for people who cannot live independently and who must move into an institutional facility. 

The big reason why it is so difficult to cover the costs of nursing home care is that this type of care isn’t covered by private health insurance or Medicare except in very limited circumstances.  Medicare has so many rules in place that it is exceedingly difficult for patients to get their stay in a nursing home paid for.  Even if it possible for Medicare to pay at all, the payment period is very limited.  On the other hand, Medicaid will pay for your stay in the nursing home, even at-home care.  Parman & Easterday can help you understand when Medicare will pay for care.  Parman & Easterday can also help you to make plans to get Medicaid to cover your long-term health care costs in circumstances when Medicare won’t cover you.

You should give us a call today to talk with an Overland Park Medicaid planning attorney to find out how we can assist you in getting essential care without having to impoverish yourself to afford it.

Medicare’s Two-Midnight Rule Makes It Hard to Get Nursing Home Care Covered

Getting Medicare to cover the costs of nursing home care is almost impossible for several different reasons.

First and foremost, Medicare only pays for skilled nursing care.  Skilled nursing care is the type of care that a medical professional or someone with specialized training must provide.  An example would be changing bandages after surgery.

Except for a very limited set of circumstances, Medicare pays nothing at all for custodial care, and that is the customary care most people actually need when they move to a nursing home care facility.

Custodial care is the type of care that can be provided by anyone, including unskilled aides. Since most people move to a nursing home care because they can’t dress, bathe or feed themselves, or move around on their own, most people need only custodial care and won’t be able to get Medicare to pay for it.

Unfortunately, even people who need skilled nursing care could face difficulty getting Medicare to pay for skilled nursing care because they may be eligible only if they meet other requirements. One requirement, for example, is that a Medicare patient must be admitted as an inpatient to a hospital.  Those services are covered under Medicare Part A.  Outpatients are covered under Part B.  Medicare has different rules, services and reimbursement rates based on whether you are admitted as a Part A inpatient or Part B outpatient.  Here’s what’s important.  If a Medicare patient isn’t admitted as a Part A inpatient, Medicare may not cover skilled care such as certain kinds of rehabilitation.

Next, Medicare will only pay for skilled nursing home care if the patient has been admitted to the hospital for three days as a Part A inpatient.  As the Medicare rules evolved, more patients were admitted as a Part B outpatient and not eligible to have Medicare pay for their skilled nursing care needs.  So, a new rule was created.

This rule is called the two-midnight rule.  In general, the Two-Midnight rule stated that:

• Inpatient admissions will generally be payable under Part A if the admitting practitioner expected the patient to require a hospital stay that crossed two midnights and the medical record supports that reasonable expectation.
• Medicare Part A payment is generally not appropriate for hospital stays not expected to span at least two midnights.

The question is, “What does this do for people entering the hospital who may need skilled care?”  As Motley Fool explains, the two-midnight rule makes it less likely for patients to be admitted to the hospital as inpatients because doctors are supposed to admit them only if it is likely that they will spend at least two midnights in a hospital.

Doctors may decline to admit patients who might experience complications after procedures thanks to the two-midnight rule, since if those patients don’t end up experiencing complications then they wouldn’t cross two midnights. Instead, many more people are admitted to the hospital for observation, which wouldn’t entitle them to receive Medicare coverage for certain kinds of skilled nursing care after departing the hospital.

Patients are also less likely to be admitted if they come to the hospital on weekday mornings, as opposed to weekend nights, so the time when a person happens to get sick could affect the benefits that he or she is entitled to receive. Patients who aren’t eligible for Medicare to cover their care could end up facing very high medical bills out of pocket.

Getting Help from an Overland Park Medicaid Planning Attorney

An Overland Park Medicaid attorney at Parman & Easterday will help you to ensure that you don’t experience a financial crisis if you need nursing home care and Medicare will not pay for it. Medicaid will cover the costs of care in most circumstances when Medicaid won’t, including when you just need basic help with routine activities of daily living.  Because Medicaid is means-tested, you will need to make a Medicaid plan so you can get Medicaid to cover your costs before you spend down all of the wealth you have worked so hard to acquire.

To find out more about the Medicaid planning process, join us for a free seminar. You can also give us a call today at (405) 843-6100 or contact us online at any time to start working on your personalized Medicaid plan.