Pittsford Medicaid attorneys provide help to clients in making a plan to qualify for Medicaid to pay for the costs of nursing home care. Creating a plan to get Medicaid is very important because Medicare won’t pay anything for nursing home care or long-term care at home in the majority of circumstances where such care is needed. This could leave people stuck paying out of pocket unless they’ve worked with an attorney to make a Medicaid plan.

The Law Office of Michael Robinson, P.C. can help you to understand the rules for Medicaid and Medicare coverage of nursing home care and can provide assistance in determining if you need a Medicaid plan.

It is helpful to understand Medicare rules and coverage limitations so you can make a more informed determination about the importance of creating a nursing home plan.

How Medicare’s Two Midnight Rule Impacts Nursing Home Care

Making a Medicaid plan is so important because Medicare makes it very difficult for seniors to get nursing home care covered. One of the limitations that is imposed is a rule limiting Medicare coverage of nursing homes to skilled nursing care only.

Most people need custodial care, or basic routine help with activities of daily living. Medicare won’t pay for long-term care or nursing home care if custodial care is all that is required. It pays only if a senior needs skilled nursing care provided by someone with medical training, such as a nurse changing bandages after surgery.

Another limit on Medicare nursing home care coverage comes in the form of the two-midnight rule. The two midnight rule specifies that Medicare beneficiaries should be admitted to a hospital only if they have a medical issue likely to require them to stay at the facility over two nights. In other words, they should be admitted only if they cross two midnights in the hospital.

Patients who aren’t admitted to hospitals may be more limited in the types of recovery care they receive, including skilled nursing care. Patients are required to have a multi-day hospital stay as an inpatient in order to qualify for skilled nursing care post-release. If a patient is not formally admitted to a hospital, the patient will not get coverage for skilled nursing care that would be needed after a hospital discharge.

This two-midnight rule means many fewer patients are actually admitted to hospitals; they are instead kept on observation status so do not become eligible for post-release skilled nursing care. Unfortunately, this means even fewer seniors will be able to get Medicare to cover nursing home care for any length of time — and thus Medicaid planning becomes even more important in order to ensure that a nursing home is covered when nursing home care becomes necessary.

Motley Fool reported on research demonstrating the impact of the two-midnight rule and found up to 7.4% of the Medicare beneficiaries who were admitted to the hospital would have been considered outpatients under the rule and thus wouldn’t have actually been admitted. These patients would thus not have been eligible for the same skilled nursing care benefits they might have received if they’d been admitted.

Patients arriving on weekends or late at night were found to be more likely to get admitted to the hospital, but of course seniors cannot time when they get sick and need care.

Getting Help from Pittsford Medicaid Attorneys

Pittsford Medicaid attorneys at The Law Office of Michael Robinson, P.C. can provide personalized assistance in determining whether creating a Medicaid plan is important in order to protect your assets. We can also offer assistance with all aspects of the Medicaid planning process so you can keep your wealth as secure as possible.

To find out more about how you can create a Medicaid plan or about other steps you may wish to take to protect your wealth as you get older, join us for a free seminar. You can also give us a call at 585-374-5210 or contact us online to speak with an attorney who can help you to create a personalized asset protection plan.