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Many still unaware that Medicare covers chronic conditions

2157-Fall-GP-LEMA medicare-185x300A lot of health care providers still don’t know that the law has changed, and that Medicare now covers many skilled nursing, home health care and therapy services even if they simply maintain a person’s health and don’t improve their condition.

This is very important for seniors who suffer from diabetes, heart disease, Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, Lou Gehrig’s disease, arthritis, or the effects of a stroke, among other conditions.

Although the government launched an educational campaign about the change earlier this year, it appears a large number of providers are still in the dark and are refusing to provide treatment on the grounds that Medicare won’t cover it.

For decades, Medicare had a “rule of thumb” that coverage of skilled nursing, home health care and outpatient therapy services was available only if they were likely to improve the patient’s condition. Other treatments were considered “custodial care” and ineligible for coverage.

Now, however, seniors who are enrolled in Part A, which covers hospitalizations, are eligible for up to 100 days in a skilled nursing facility (as long as it follows a three-day hospitalization), as well as up to 100 home visits following a hospitalization – even if the services will simply maintain the person’s health at its current level.

Seniors who are enrolled in Part B, which covers doctor visits and other outpatient services, are eligible for potentially unlimited home visits.

In addition, anyone who applied for Medicare benefits after January 18, 2011 and was denied due to the “rule of thumb” can now have that denial reviewed under the new rules.



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