Grandma needed surgery. She stayed in the hospital hospital for 35 days, was in a nursing home for 64 days, and then fell and broke her hip. Does Medicare restart?

She was in the skilled nursing home since Sept 5 (64 days) and got up to get to try to get a tissue and fell and broke her hip. She was admitted into another hospital and is currently recovering from the surgery that put a rod/screws etc. Would her Medicare restart because of her hip break incident? She receives Medicare under United Health Care PPO.

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Under Medicare Part A she still has 36 days of her 100 Medicare Skilled Nursing Facility benefit available during this "Benefit Period". A Benefit Period is defined as any period of care separated by a least 60 days during which care is not received. Part A benefits are not calculated on a calendar year basis as Part B and D are.

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I believe there is a period of time with no claim that has to occur to start a new covered "hospital stay". I don't know if the facility she was in when she broke her hip has any responsibility or not but I do know that they along with any other facility she was transferred to during all of this should have gone over coverage with you. I also think there may be a possibility that some of her supplemental might pick up a portion...but don't quote me on that. It would be really good though to consult with someone at the hospital that knows the ins and outs of this, they can look at all of her coverage's (not just the Medicare) and help you figure out the best way to do things. The hospital and Rehab should have an expert on staff just for this sort of thing.

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There has to be 60 days break...the case manager at the hospital should have explained this to you. Even though my dad had two different fractures requiring two different stints in rehab and hospital there wasn’t 60 days between them and he had already used enough of his 100 days that he only had 35 left. So we opted to private pay respite days in rehab while he was unable to bear weight. Then we will begin medicare in 2-3 weeks when he can bear weight for therapy to begin. As long as we opt back in within 30 days we won’t lose those remaining days. I tell you it’s been an interesting learning experience about Medicare.

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It is my understanding if a person transfers back and forth from hospital to nursing home (skilled care) there is never a 60 day break from "hospital care" and therefore a new hospital stay can never occur. This is the cause of many Medicare patients running out of benefits because there subsequent visits to hospital are considered continuous care and after the 60 day reserve days expires a patient no longer is covered by Medicare.

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jjariz might be correct - but I think it would just start again due to the hip breaking.

your best bet is to get in touch with Medicare - you can also ask at the hospital as they handle the billing. you can also contact United Health Care PPO directly and find out.

but the way it was explained to me, the hip breaking is another situation entirely and would be covered.

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You need to have a 60 day break for the restart to occur.

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Grandma needed surgery. She stayed in the hospital hospital for 35 days, was in a nursing home for 64 days, and then fell and broke her hip. Does Medicare restart?

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