• #10050 "Medicare and You, 2005"

• #10116 "Your Medicare Benefits"

• #10112 "Your Medicare Rights and Protections"

• #10153 "Medicare Coverage of Skilled Nursing Facility Care"

Most of you are aware that you have either Part A benefits, Part B benefits or both. Each of you also receives a yearly booklet that outlines all your benefits and tells you about any changes. In addition, most of you know that Nursing Home Care is generally not a covered service because it is considered custodial care.

Medicare Part A only covers care that is skilled and given in a certified Skilled Nursing Facility, also called a SNF. A SNF may be a part of a hospital, a part of a nursing home or it can be a separate facility but you must be in a "certified" bed to receive the skilled care Medicare pays for.

If you are transferred from a hospital to a SNF, the hospital discharge planner may tell you that you have 100 days of Medicare Skilled care in the facility you are going to. This is not totally accurate. Medicare will pay for certain skilled services that are required on a daily basis for up to 100 days if needed. It is very important that you and your family are aware of this. You are urged to call 1-800-633-4227 if you have any questions about this. TTY users may call 1-877-486-2048. You may also order any of the Medicare publications such as those at the top of this page by calling these numbers. The publications are free of charge.

Another area of concern about your rights is addressed in Publication #10116 and it pertains to the end of your skilled care needs in a SNF. The facility where you are receiving skilled care on a daily basis is obligated by law to tell you when your Part A Medicare covered stay will end and why. They are also obligated to give this to you in writing no later than the last day they feel your services will be covered. This information must be given to you and/or your family or representative in a format that you can understand.

This form is called a "Notice of Non-Coverage" or an "Advance Beneficiary Notice" (ABN) and will require your signature. In this document, the facility is telling you that in their opinion, you no longer require daily skilled services so they feel Medicare will not continue to pay for your care at the level you have been receiving.

You have the right to disagree and ask the facility to submit a bill to Medicare on your behalf. This is called a Demand Bill and there is a box on the form you sign that you check saying you want Medicare to be billed.

Medicare then reviews your claim and if they agree with you, your skilled care will continue and the facility will have to pay the bill for the period of time between when they said skilled care will end and the Medicare decision is made. If Medicare agrees with the facility, you may be liable for those charges.

In either situation, you will receive a Medicare Summary Notice (MSN) which explains the decision. If Medicare agrees with the facility, and you feel it was the wrong decision, you still have your appeals rights, up to 120 days after you receive the MSN. Directions for filing the appeal can be found on the back of the MSN.