What is Medicare and what costs does it cover?
Medicare is a federal health insurance program for people who are 65 or older, have been disabled for at least two years, or have End Stage Renal Disease.
What is Medicare Part A and Part B and what costs are covered?
There are two types of traditional Medicare coverage. Medicare Part A provides for hospital insurance for costs incurred while you are in the hospital. Medicare Part B provides medical insurance for costs of physician services, the cost of an ambulance, outpatient medical services and hospital supplies. The patient is responsible for a deductible for each of these service categories each year.
What are the qualifications to use Medicare for Skilled Nursing care?
You must have a prior Medicare-covered inpatient hospital stay of at least three days (not counting the day of hospital discharge). Your admission to a Medicare-approved Skilled Nursing facility must be within 30 days of discharge from the hospital or within 30 days of a previous Medicare-covered hospital stay. Your doctor must have certified that following your hospital stay, you require a daily skilled service provided by a licensed nurse or therapist in a nursing facility that is Medicare certified.
What are the services and supplies covered by Medicare?
Your room and board, routine nursing care, medical supplies and complex equipment, medicines and physical, occupational, speech and respiratory therapy. Oxygen and lab services are covered. Also covered are X-rays, EKGs and intravenous medications you may need. Personal convenience items, private duty nurses, custodial nursing care and the extra cost of a private room are not covered.
How long will Medicare Part A Cover Skilled Nursing facility costs?
In a Medicare-certified Skilled Nursing facility, Medicare will cover up to 100 days per benefit period after a three-day Medicare-covered inpatient hospital stay and physician confirmation that there is a need for daily, Skilled Nursing and/or rehabilitative care in a Skilled Nursing facility. There is a co-insurance cost per day for days 21-100. This means the patient will pay for co-insurance costs through private insurance or out of pocket. Expenses beyond 100 days are not covered by Medicare Part A benefits.
What is Medicare Part C and D?
Medicare Part C is also known as a Medicare Advantage Plan. The Medicare Advantage Plan is an insurance policy offered by private insurance companies approved by the Centers for Medicare & Medicaid Services (CMS). When a person enrolls in a Medicare Advantage Plan, the plan will cover all of Part A, Part B and sometimes Part D coverage. Part D coverage is insurance coverage that subsidizes Medicare coverage for the costs of medicine.
The Medicare Advantage Plan often offers extra coverage above and beyond traditional Medicare and covers expenses for such costs as vision, hearing, dental or wellness programs. Each insurance company that offers a
What is Medicaid and what costs does it cover?
Medicaid is a federal and state-funded medical assistance program that pays for approved and needed medical care for persons who meet specific eligibility requirements. A medical assistance recipient remains eligible for nursing facility care for as long as that level of care is approved and the person continues to meet all financial and other requirements.
What important documents should I bring?
Either prior to or during the admissions process, you must present your Medicare card, Medicaid card, Managed Care or Insurance card, Social Security card, Medicare Part D (drug benefit) card, Advanced Directives, Living Will, etc. (if applicable) and any Long-Term Care/Supplemental Insurance policies. Our admissions personnel will review all state and federal programs that you could be eligible for and explain the benefits and requirements to you. They will also explain the services available in the nursing community to assure that all of your concerns are addressed. You may also meet with a member of our business office to review any financial questions that center around your Medicare, Medicaid or Insurance policies. During the assessment process we will also review your payor sources and help you understand how billing will take place.
What if I am admitted from home?
Our goal is to provide each resident with a smooth transition into our community, while meeting the federal, state, and local requirements. Our admissions coordinator will be of great assistance to you. The first step is pre-admission screening approval.
What if I am admitted from the hospital?
Following the clinical assessment, the admissions team will work with the hospital staff to arrange placement into the Skilled Nursing community. The hospital staff will provide the medical information to ensure a smooth transition. It will be necessary for you or a family member to complete admission paperwork before or the day of admission.
What happens once I arrive at a nursing community?
A member of our nursing team will meet with you to gather clinical information, perform a clinical evaluation and orient you to our community. The admitting nurse will discuss a number of clinical aspects related to your diagnosis, medications and activity level. You will be assessed from head to toe to note any conditions that may need to be addressed immediately and during your stay. Also, you will be weighed periodically to maintain your weight record. Clinical interventions are focused on the special needs of our residents and are designed to promote a safe and timely discharge.
Will my family be involved?
Members of the interdisciplinary team will meet with you or your loved one shortly after admission. The team includes the therapy staff, registered dietitian and social services. They will collect important details about your diagnoses, clinical and psycho-social needs, lifestyle and discharge plan. It is a goal setting meeting designed to provide a “road map” for your expected recovery. This meeting will include a discussion about your nursing needs, therapy goals, expected length of treatment, psycho-social needs, discharge planning, and educational needs.
Can I bring personal items?
We encourage you to bring personal items as space allows. All personal belongings should be labeled with your name. Any electrical item, such as lights, TVs and radios, must be checked and approved for use by our maintenance department. All clothing should have your name either on a label sewn to the garment or written on the garment in permanent ink.
Please also bring:
- Eye glasses
- Hearing aids
- Personal effects
- Reading materials
What clothing should I bring?
Women should bring four or five dresses and blouses or tops; two or three sweaters, eight undergarments, pajamas, gown and robe, non-slip shoes and a coat. Men should bring four or five pairs of slacks and four or five shirts, eight undershirts and shorts, two or three sweaters, pajamas, a robe, non-slip shoes and a coat. Depending on which service line they will be utilizing, alternative lists of suggested items may be given.
Please do not bring:
- Electric blankets
- Combustible items
- Glass or breakables
- Large sums of money or credit cards
- Extension cords