“They told his wife he had to leave”
He was already my client. Then his wife called me — he was in a skilled nursing facility, and they'd told her that after day 20 his insurance wouldn't cover him.
That's not what was happening. For eligible skilled nursing care, Medicare's maximum is 100 days per benefit period; after day 100, the patient is responsible for the full cost unless other coverage applies. Many Advantage plans use a similar day limit, although copays and coverage rules vary. In his case, coverage didn't stop on day 21 — the patient just started paying a daily copay. What the facility was really doing was managing its own risk of not getting paid.
The part that worries me most is what facilities often suggest next: drop your Advantage plan and go back to Original Medicare. That's good for the facility. For the patient it can mean $217 a day with nothing to cover it, no drug coverage, and no easy way back.
I found him coverage that paid the whole stay with no daily copay, then drove to the facility and showed them in person exactly what he was entitled to.
He stayed 45 days — twenty-five past the day they said he had to be out. He still thanks me for it.
You can push back without an agent, too. The facility must give you written notice at least two days before Medicare coverage ends, and you have the right to a fast independent review before any discharge. Most families are never told that.
