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Understanding your Skilled Nursing Medicare Benefits

Medicare offers an opportunity to receive quality health care for a wide range of conditions. Many patients of Heartland and ManorCare so we developed this blog to help you understand this often confusing topic for a skilled nursing facility stay*.

What is Medicare?

Medicare is our national health insurance program. Social Security recipients over the age of 65 or those who are permanently disabled are eligible for Medicare coverage. Medicare is similar to the coverage provided by private insurance companies. It pays a portion of the cost of your medical care and may require co-insurance or deductibles. It is not a welfare program and should not be confused with Medicaid.

What is the difference between Medicare Part A and Part B?

Medicare Part A covers inpatient hospital care, hospice care, inpatient care in a skilled nursing facility and some home health care services. Part B covers medical care and services provided by doctors and other medical practitioners, some home health care, durable medical equipment and some outpatient care and home health services. 

What is covered by Medicare?

Medicare can help pay for these items within our skilled nursing and rehabilitation centers:

  • Semi-private room
  • All meals, including special diets
  • Use of items such as braces, splints and adaptive equipment
  • Medical supplies
  • Nursing care
  • Rehabilitation services including physical, occupational and speech therapies

 

What is not covered by Medicare?

  • Private-duty nurse
  • Barber and beautician services
  • Private telephone and television
  • Long-term or permanent residency stay

 

When do Medicare benefits apply to me?

Medicare is designed for those needing short-term medical care. You can receive Medicare benefits under most circumstances if: 

  • You have been admitted to the hospital for three consecutive days**, not counting the day of discharge,
  • You are transferred to a nursing center for further care of the condition that was treated in the hospital or other conditions requiring skilled nursing or rehabilitative services,
  • Your physician certifies that you require skilled or rehabilitation care after the hospital stay.

 

How does Medicare cost coverage work?

Medicare Part A will pay 100% for your first 20 days in a Medicare certified skilled care facility. Days 21-100, Medicare will pay a portion of your care. You will be responsible for the balance or co-pay.

Your co-pay responsibility, days 1-20:  $0.00
Your co-pay responsibility, days 21-100:  $164.50***

 

What about Part B coverage?

Part B services are usually those services provided by an outside provider like physician services, x-rays, therapy, labs, certain ambulance fee and nutrition supplies. In 2010, Medicare mandated Part B enrolles to pay Part B premiums based upon their income. Our admissions ream can provide you with additional information.

Part B deductible is:  $183.00***

and there is a 20% Part B co-pay on allowable charges.

 

What else should I know about Medicare?

Ask our admissions team about follow-up care and the 30-day window coverage. If you feel you need more care or have additional issues with you health care condition, Medicare might still cover your skilled nursing or rehabilitative needs.

About us

Heartland and ManorCare Health Services centers provide skilled nursing and rehabilitation services. Our caregivers will be happy to help you review your options and access the appropriate resources so you can take advantage of your Medicare benefits. Please feel free to contact our team today for more information about our services and support. Also, visit our website for more information or payment options.

 

 

* Additional information about Medicare coverage can be found at medicare.gov.

** To ensure your post-hospital stay benefits, check with the hospital social services to ensure that you have been admitted and are not under observation care status.

*** As of January 1, 2017

 

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