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Newsletter Archives > Medicare Will Pay The First 100 Days in Nursing Home, Right?


27 Feb 2008

Medicare Will Pay The First 100 Days in Nursing Home, Right?
For Agents Information Only....


I hear it all the time from brokers ----> "I show a 90-100 day elimination period because it's "CHEAPER" and Medicare Pays the first 100 days anyway."

Well, what's your opinion on this?

I have a couple things you should consider before you jump on the 90-100 day EP bandwagon:
  • How old is your client? Believe it or not, I have some brokers selling longer elimination periods on the assumption that Medicare Will pay AND their prospects aren't even on Medicare Yet!  That's right some of them are in their 50's......so what happens if they get hit by a Mack Truck or fall off a horse (like Superman) before they turn 65?
  • How much "CHEAPER" is it really? First figure out the amount of premium savings.  Second take the daily benefit amount and multiply that by the elimination period ....ie. $300/Day X 100 Days = $30,000.  So in effect you just gave them a $30,000 deductible and for what?  A few hundred, maybe a thousand bucks?  AND When do you have the most chance of needing services anyway?  During the first 100 days or after?
  • Even if your prospect is on Medicare are you aware of Medicare's requirements that must be met BEFORE they will pay?  If not see chart below.

If they ARE on Medicare this is what happens:

FIRST, they must meet the following requirements (NOTE: it's for "SKILLED" care - that's the highest level of care.  If you get bumped down to an intermediate level of care guess what????  They won't pay.......This exact thing happened to my own grandfather and it's not uncommon!

SKILLED NURSING FACILITY CARE
You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital.

If all that was satisfied and they are now in a Medicare Approved "SKILLED" Nursing Facility this is what they will be entitled to from Medicare:


Services.........................................Medicare Pays..................................You Pay
First 20 Days...................................
All "approved" amounts........................$0
Days 21-100....................................All But $124/day..................................$124/day
Days 101and on.............................$0.......................................................All Expenses

Now if the above happens to work out for you, a good Medicare Supplement will pick up the $124/day but after 100 days you're on your own.

Why not offer a quality Long Term Care plan with the minimum elimination period so their Deductible is lower.......ie. $300 X 30 Days = $9,000 (Vs. $30,000) ?

Hope this helped.

25 Years in the Senior Market -- Let us help you be successful today:

Todd Concklin