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lvandoorn1 Asked October 2010

I have medicare A + B. Will it cover temporary care?

EXPERT Ralph Robbins Oct 2010
It depends on what you mean by "temporary care". Medicare (I am referring here to "original" Medicare. If you have a Medicare Advantage Part C contract, read your contract) only covers Skilled levels of care whether in a facility or at home. This means that services required must be ordered by a physician and performed by a licensed professional. The patient must be "improving" as a result of therapies and treatment. Once the patient is "no longer improving" Medicare will no longer pay for services.

In a facility Medicare will provide benefits if:
1. The patient is hospitalized for at least 3 days.
2. Enters a Medicare approved facility...
3. for the same condition for which they were hospitalized...
4. and does so within 30 days of discharge.

Under these circumstances Medicare will pay full costs for the first 20 days. After 20 days Medicare will provide coverage for another 80 days but there is a co-payment which is usually covered by Medicare supplements. This is per benefit period, no annually.

At home, Medicare will pay for intermittent skilled services paid at 100%. The care must be physician ordered. When receiving skilled services at home, a professional such as an respiratory, occupational, or physical therapist, etc. will come to the home, perform a service, and then leave. While receiving Medicare home services SOME home health services may be provided; for instance an aide may be sent once or twice a week to assist the patient with bathing. Once skilled services end, so do any home health aide services.

Under no circumstances does Medicare pay for ongoing custodial or personal care services at home or in a facility.

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