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Medicare is a
benefit provided by the Federal government that helps
cover residents in a Skilled Nursing Facility (SNF). residents 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 ispersonal 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 in resident 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
inresident care.
Ends when you have
been out of the hospital and not receiving in
resident 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 resident/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
resident/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
Outresident 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)
Medicaid
Medicare