Globe Syndicate

For release Friday August 20, 2004

The Sandwich Generation . . . Helping Your Aging Parents

by Carol Abaya, M.A.

MEDICARE WILL PAY FOR

MULTIPLE AMBULANCE BILLS

Question: I’m very confused about what Medicare pays for in relation to nursing homes. The home said my mother doesn’t qualify. She’s not really sick, but is bedridden.

Question: I thought Medicare paid for a nursing home. My father cannot be cared for at home. I’m told Medicare won’t pay.

Question: My mother was in a nursing home for 15 days and then was able to go home. Three weeks later, she broker her leg and again needed nursing home and rehab care. Will Medicare pay?

Answer: Medicare coverage criteria are really straight forward.

1. Medicare pays for skilled nursing home care for up to 100 if there is a medical reason for the needed care. It pays for all costs for the first 20 days. The patient pays a co-payment for days 21 to 100.

2. Once you have been out of the hospital or SNF for 60 days, another 100 day benefit period begins.

3. Medicare pays for SNF if you have Medicare Part A insurance and have been in the hospital for three consecutive days; your doctor certifies you need skilled care; and the SNF is certified by Medicare.

In the first example, your mother must have Part A insurance, been in the hospital three days, and have a doctor certify skilled care is needed. From what you said, this is not the case.

In the second case, unless your father has been in the hospital and needs medical -- rather than just personal care, Medicare again will not pay.

In the third situation, yes, Medicare should pay in full for the first 15 days and partially from day 21 to 100.

A booklet “Medicare Coverage of Skilled Nursing Facility Care” is available by calling 1-800-633-4227. Some booklets are also available in Spanish and Chinese. Publication #CMS-10153 for nursing home information.

Question: My aunt, 80, has been in and out of the hospital, rehab and sub-acute care facilities at least six times in the past three months. We’re getting bills for hundreds of dollars from the ambulance companies. Shouldn’t Medicare pay?

Answer: Yes. Medicare will pay if (1) it is a life threatening situation (e.g. from the house to the emergency room) and/or (2) the doctor deems it “medically necessary.”

Question: I took both my parents (late 70s) to the eye doctor for an examination, and Medicare refuses to pay. Should it pay?

Answer: Medicare will not pay for “routine” eye care or yearly physicals. The key is the word “routine.” If your parents have a specific problem, then Medicare should pay.

Medical Bill Paying Advice: Whenever medical bills start coming in, especially if you are dealing with daily crises, don’t pay them right away. Check with Medicare and your supplemental insurance company to verify what they will pay. Nothing is going to happen to you if you wait even several months to pay medical bills.

Are you juggling doing errands for your aging parents, your children, yourself and working at the same time? Are you tired, stressed out and upset that your once vibrant parent is now frail and needy?

Do you feel alone? Rest assured you are not alone! The Sandwich Generation is dedicated to the 50 million Americans who may have elder/parent care concerns and/or responsibilities.

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Do you have a question? Send it in. Although letters cannot be answered individually, appropriate letters will be answered in this column whenever possible. Letters may be edited. Send letters to Ms. Carol Abaya, mail direct to her at PO Box 132, Wickatunk, NJ 07765-0132 or contact her through her web site: thesandwichgeneration.com.

Carol Abaya is an international-award-winning journalist and creator of the unique magazine The Sandwich Generation: You & Your Aging Parents.

NOTES TO EDITORS: text = 542 words; other material = 160 words

We would appreciate it if you would include the "Globe Syndicate" bug at the end of the column.