Seniors Sue Medicare To Close Nursing Home Coverage Gap

Roberta Baxter, a 78-year-old retired instructional assistant for the Killingly school system, dislocated her kneecap after a fall in her bathroom last September. Following treatment at a local hospital, she spent seven weeks at a nursing home for rehab so that she could walk again. While she was recovering, she and her husband Bill received the first of several bills from the nursing home.  That’s when the couple learned Medicare wouldn’t cover the $16,000 cost because Roberta didn’t spend at least three consecutive days in the hospital as admitted patient, or inpatient, as Medicare requires.  Instead, the four days she spent in the hospital was for “observation care.”

“I thought it was surely a mistake,” she said. “Nobody ever said I wasn’t admitted.”

Last Friday (5-3), lawyers representing 14 seniors, including 7 from Connecticut, appeared in U.S. District Court in Hartford to ask a judge to eliminate the observation care designation because it deprives Medicare beneficiaries of the full hospital coverage they’re entitled to under Medicare, including coverage for follow-up nursing home care. The judge did not rule on the case.  The Centers for Medicare & Medicaid Services (CMS), which runs the Medicare program, pays for doctor visits, hospitalization, nursing home care, prescription drugs and other benefits for nearly 50 million older or disabled Americans, including about 586,000 in Connecticut.