|
Medicare
Medicare is a
benefit provided by the Federal government that helps cover
patients in a Skilled Nursing Facility (SNF). Patients who no
longer need intensive hospital care but still need skilled
nursing care and rehabilitation services on a daily basis can
use their Medicare benefits. However, Medicare does not cover
long term care or nursing home care that is personal or
custodial (example: help with dressing, bathing and eating).
Medicare has Two
Parts:
Part A
(Hospital Insurance) - hospital care, home health care and care
in a Skilled Nursing
Facility. If you are eligible for Medicare, you do not pay a
premium for Part A. If you are not
eligible, you may
enroll by paying a monthly premium.
Part B
(Medical Insurance) - helps cover many medical services and
supplies not
covered by Part A.
Part B coverage requires a monthly premium.
To be eligible
for Medicare benefits, you must be:
Age 65 or
older and have worked long enough to be insured under
Social Security, the Railroad
Retirement system or
the federal government.
Under 65 and
have received disability benefits through Social
Security for more than 24
months.
Already
receiving benefits from Social Security or the Railroad
Retirement System.
A person who
has permanent kidney failure
If youre covered by
Medicare, you can qualify if you meet all
conditions. You must:
Be certified
by a Doctor that you need daily skilled nursing or
rehabilitation services.
Need daily
care that can only be provided in a Skilled Nursing
Facility on an inpatient basis.
Have been in
a hospital for at least 3 consecutive days, not
counting your day of discharge.
Be admitted
to a Medicare-Certified SNF within 30 days of your
hospital discharge.
Receive Care
in the Skilled Nursing Facility for a Condition that was
treated in the hospital.
MEDICARE PART A
Medicare Part A
insurance helps cover up to 100 days of care in a Skilled
Nursing Facility per benefit, if needed.
Part A Benefit
Period
Begins the first
day you are admitted into a Skilled Nursing Facility for
inpatient care.
Ends when you have
been out of the hospital and not receiving inpatient Skilled
Nursing
Facility care for 60 days in a row.
There is no limit
to the number of benefit periods you can have for Skilled
Nursing
Facility care.
Benefit Period
First 20
days of a benefit period - Medicare Part A pays all
costs that are covered for Skilled
Nursing Facility care.
Next 80 days
of a benefit period Medicare Part A pays all covered costs
over $114.00 per day.
The $114.00 per day
is called a co-pay which must be paid by the patient/resident
or an
insurance company that covers the co-pay amount.
Skilled
Nursing services that Medicare Part A helps cover:
A 2 to 4 bed
semi-private room
All meals,
including special diets
Nursing Care
Therapy
Medications
Medical supplies such as splints and casts
Medical equipment
such as wheelchairs
MEDICARE PART B
Medicare Part
B helps pay for certain medical services and supplies
that Medicare Part A does not cover.
Under Medicare
Part B:
You pay the yearly
deductible.
After you meet the
deductible, Medicare usually pays 80% of charges.
The additional 20%
is called co-pay which must be paid by the patient/resident or
an insurance
company that covers the co-pay amount.
You also have to
pay for any amount over the approved costs.
Medicare Part
B helps cover:
Physician services
Diagnostic tests
Certain ambulance
services
Outpatient
hospital services
Physical,
occupational, and speech therapy
Medical equipment
used at home
Mental health care
Services of other
healthcare professionals such as chiropractors, podiatrists and
dentists
under limited
circumstances
Other services and
supplies such as pap tests, mammograms, prostate cancer
screening,
and home health
care (if the person does not have Part A)
|
