QUESTION: My mother has been in and out of hospitals for the past two years. She used her 100 days in a skilled nursing facility and now my father is paying the bill. She went back in the hospital for four days. I thought that if you were hospitalized and returned to a skilled nursing facility the 100 days started over. The financial representative at the facility told me there were more stipulations than that. Is this true?
ANSWER: The financial person at your mother’s facility was correct. The non-coverage at the facility has to do with the “benefit period” not the return to the hospital.
A benefit period begins on the day you enter the hospital or skilled nursing facility and ends 60 days after you have not received inpatient care at the hospital or skilled nursing facility.
Your mother has never ended her initial benefit period as she has not had 60 days without inpatient care. Therefore, she has used up her 100 days for the benefit period and is not entitled to another 100 days in this same benefit period.
If she were to be released from the skilled nursing facility and go without the need for inpatient care in a hospital or skilled nursing facility for 60 days then the benefit period would close.
Then if she again needed care and went to the hospital for at least three days she would open a new benefit period and be entitled to up to another 100 days of skilled care or therapy at the skilled nursing facility.
If a patient is covered by a Medicare Senior Advantage plan (an HMO or PPO) instead of traditional or original Medicare the process is different. If this is the case you should check with your particular plan to be sure of its rules and cost for such coverage.
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HAPPENINGS:
SATURDAY – October 12 – 5:00 pm –BRATS & BEER OKTOBERFEST – at Goebel Adult Community Center, 1385 E. Janss Road in Thousand Oaks – come and enjoy a night filled with fun – dinner – dancing – friends and beer – tickets are $10 per person.
SUNDAY – October 20 – 3:00 to 4:30 pm – Music Comes Alive – “KiKi Ebsen presents “Musical Memories of Buddy Ebsen” the youngest daughter of entertainer Buddy Ebsen will share Buddy’s life stories – at Goebel Adult Community Center in Thousand Oaks. Tickets are on sale at the Goebel front desk – $7.00.
Medicare 2020 Seminars – come and learn about Medicare coverage for next year:
Wednesday October 16 – 1:30 to 3:00 pm at Westlake Village Civic Center, 31200 E. Oak Crest Drive in Westlake Village. For information call (805) 495-6250.
Thursday October 17 – 10:00 to 11:30 am at Agoura Hills Event & Recreation Center, 29900 Ladyface Court in Agoura Hills. For reservations call (818) 597-7361.
Tuesday October 22, 4:00 to 5:30 pm at Senior Concerns Day Care Center, 401 Hodenamp Road in Thousand Oaks. For reservations call (805) 497-0189.
HEAR YE – HEAR YE – the newly remodeled CSVP Boutique at the Goebel Center is now open and newly stocked with handmade gifts, other unique items and an array of greeting cards for 50 cents each. Open Monday through Friday from 9:00 am to 4::00 pm – come and explore this beautiful and well stocked shop!
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Betty Berry is a senior advocate for Senior Concerns. The advocates are located at the Goebel Adult Community Center, 1385 E. Janss Road, Thousand Oaks, CA 91362 or call (805) 495-6250 or e-mail bberry@seniorconcerns.org (please include your telephone number.) You are invited to submit questions on senior issues.
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