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There are several methods of payment for long-term care services. The following information has been compiled to clarify the eligibility requirements and benefits of each method and to help you determine which source best suits your needs.
MEDICARE
Medicare is a federal health insurance program for people age 65 or older and people under 65 with certain disabilities.
Part A (Hospital Insurance)
Medicare Part A helps to cover the cost of care in a Skilled Nursing Facility (SNF) for a specific benefit period (up to 100 days) if:
• You have been in a hospital for at least three consecutive days;
• You have been admitted to the facility within 30 days of leaving
a hospital (with a three-day qualifying stay); and
• Your physician certifies that you need skilled nursing or
rehabilitation services on a daily basis.
Day 1 through 20: Medicare pays 100% (except personal items).
Day 21 through 100: Medicare pays all except $124.00 per day co-insurance and personal items.
MEDICAID
Medicaid is a state-administered health insurance program that covers long-term care for elderly people who have a disability and/or are low-income. Our facility will initiate the Medicaid application process for you. The Medicaid Program, however, determines whether or not it will assist in payment for the nursing facility care and services we provide to you. In most cases, Medicaid will make an eligibility decision within 45 days.
The Medicaid office will determine the monthly amount of liability payable to the facility from the resident’s income, less $38.00, life and/or burial insurance.
PRIVATE PAY
The full cost of services (room, board, meals, medication, etc.) may be paid entirely from private funds. We will not at any time prohibit anyone from applying for Medicaid program benefits and, thus, will not require anyone to remain in private pay status for any period of time. It is imperative, however, that the resident or resident’s family inform our social services director before personal funds will no longer be available so that we may assist in applying for financial assistance.
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