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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 111495
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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My wife suffered a stroke on October 19, 2015. After an 8

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My wife suffered a stroke on October 19, 2015. After an 8 day hospital stay, she went into a skilled nursing facility for physical and occupational therapy. She was covered by private insurance until December 31 and the insurance covered most of the costs. On January 13, 2016 she turned 65 and she enrolled in Medicare effective 1/1. The SNF and Medicare both say she would have needed another minimum 3 day hospital stay in order for Medicare to pay any benefits for room and board in the SNF. We had to pay out of pocket, $14,000. I find this absurd and I don't see anything in the Medicare guidebook that says the hospital stay must occur while the beneficiary is covered by Medicare. Do you think Medicare should pay for some of her benefits?
Submitted: 2 months ago.
Category: Legal
Expert:  Law Educator, Esq. replied 2 months ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.
The SNF and Medicare are correct in that if she was not on medicare at the time of entry into the SNF, she would have needed to go to the hospital to satisfy their 3 day stay requirement once active medicare benefits were approved (https://www.medicare.gov/coverage/skilled-nursing-facility-care.html) and return as then medicare would not consider it a pre-existing nursing care visit. Otherwise, I am afraid medicare would not have to pay and if you cannot qualify for medicaid, you have to pay out of pocket I am sorry to say.

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