Medicare FAQs, Tips and Nasty Surprises

Here we cover 2 types of comments – short and not so short. If it's short, you'll find it at the bottom of this page in Quick FAQs, Tips and Nasty Surprises. If it's a little longer, we've provided a link to another page; those links are just below this paragraph.

Medicare – How and when to enroll in Medicare

HMOs – Should you enroll in a Medicare HMO?

HMOs – What if your plan leaves Medicare?

Hospitals – What should you know when your loved one is a Medicare patient?

Medicare Supplemental Insurance – How do you choose the best policy?

Patient Privacy – A frustrating 2-edged sword. Here's how to overcome the problems.

Prescription Drugs – What does Medicare's new benefit mean for you?

Preventive Care – What does Medicare cover?

— Quick FAQs, Tips and Nasty Surprises —

Home Health Care Agencies – What is the most important question to ask when you are discharged from a hospital?

"Is your agency certified by Medicare?"

Medicare patients are often discharged from a hospital and need home health care to complete their recovery. However, Medicare won't pay for it unless the care is provided by a certified agency. But, only half of all home health care agencies are certified. Don't automatically assume that an agency is certified by Medicare, even if your doctor recommends it. ALWAYS ask the agency. If you have to pay for their services out of your own pocket, recovery care at home can be very expensive – often thousands of dollars. Remember: If you are discharged from a hospital and need home health care while you recover, ask if the agency is Medicare-certified BEFORE you hire them.

Tip: Many excellent home health care agencies are not certified by Medicare. But, it isn't because they aren't good enough. Instead, their nursing care plans only provide services that aren't paid for by Medicare, but which their clients need in order to remain in their own homes.

FAQ: Will Medicare pay for home health care if you live in an assisted living facility?

Even though Medicare benefits don't cover your assisted living expenses, they will pay for home health care you need to recover after a stay in a hospital, and for therapy if prescribed by your doctor. In other words, Medicare benefits cover the home health care you need to recover regardless of whether you live in an assisted living facility, a house, your children's home, an apartment or an independent living facility.

Skilled Nursing Facilities / Nursing Homes – What if you don't like the one where you are sent to recover?

If you or your family moves you into another skilled nursing facility, Medicare won't cover you there, even if the second one offers you a better chance for full recovery. Instead, you'll have to pay the entire cost of your stay in the second facility out of your own pocket.

Nasty Surprise #1

If a hospital discharges you and sends you to a skilled nursing facility for recovery, you have to pay the cost of transportation out of your own pocket, even if an ambulance is used. Medicare only pays for transportation in cases of emergency; most facility transfers don't count as emergencies.

Nasty Surprise #2

If you are a Medicare patient recovering at home or in a skilled nursing facility, you must show continual improvement. If you stop improving, Medicare considers all future care you receive to be custodial care that they don't cover. As a result, Medicare benefits stop and all costs to continue your care come out of your own pocket.