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Paying for Healthcare Services

Outlined below is the coverage a patient should expect to receive from Medicare and other agency programs for the following healthcare services.

To access the most current and more detailed information on Medicare coverage please visit Medicare's website, or read this  10-page excerpt from Medicare's 140-page booklet, "Medicare & You 2013." summarizing the costs and coverage for Medicare Parts A and B.

If you have questions regarding this information or need additional information, please give us a call toll-free at 877-823-8375 or e-mail us at ask@goldenliving.com.

 

Medicare Parts A and B

 

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Skilled Nursing Care

For a Medicare eligible beneficiary, Medicare Part A coverage pays for a semi-private room, meals, nursing services, rehabilitation services, medications, supplies and durable medical equipment for up to 100 days. For the first 20 days in a nursing home, Medicare covers 100 percent of skilled care. From Day 21 through Day 100, the resident must pay a daily co-insurance rate.

Patients who are eligible for the services covered under Medicare Part B will be responsible for an annual deductible plus 20 percent of the total charges for services such as occupational therapy, physical therapy and speech therapy, as well as medical supplies.

For additional information on Medicare's skilled nursing care coverage, read this excerpt from Medicare's 140-page booklet, "Medicare & You 2013."

 

Rehabilitation Therapy

For those Medicare beneficiaries with Part B coverage, Medicare helps pay for medically necessary physical, occupational therapy and speech-language pathology services when a doctor or therapist:

  • Sets up the plan of treatment
  • Periodically reviews the plan to see how long the patient will get therapy

You can receive your outpatient services from a participating:

  • Hospital
  • Skilled Nursing Facility
  • Home Health Agency
  • Rehabilitation Agency
  • Public Health Agency

You can also receive these services from a Medicare-approved physical or occupational therapist, in private practice.

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

For additional information on Medicare's rehabilitation therapy coverage, please read this 4-page excerpt from Medicare's 140-page booklet, "Medicare & You 2013."

 

Home Health Care

To be eligible for Medicare home health coverage, a Medicare-eligible patient must be homebound, under a physician's care and in need of medically necessary skilled nursing, physical therapy, speech-language pathology services or continued occupational therapy. A physician must authorize and periodically review the patient's home health care plan, and the home health agency must be approved by the Medicare Program (Medicare-certified).

The patent may be billed for:

  • Medical services and supplies that Medicare doesn't pay for
  • 20% of the Medicare-approved amount for Medicare-covered medical equipment such as wheelchairs, walkers, and oxygen equipment.

AseraCare Home Health is a Medicare-certified home health agency. For more information on what areas they serve and how they may help you please click here.

For additional information on Medicare's home health care coverage, please read this excerpt from Medicare's 140-page booklet, "Medicare & You 2013."

 

Hospice Care

When a Medicare-eligible patient receives services from a Medicare-approved hospice agency, Medicare will pay for the services and supplies directly related to the patient's hospice diagnosis.

The following services, which are directly related to the patient's hospice diagnosis, are covered:

  • Doctor care
  • Nursing care
  • Drugs for pain relief and those related to the terminal illness
  • Counseling services for the patient and family members
  • 13-month berevement counseling for family members

The following medical supplies, which are directly related to the patient's hospice diagnosis, are covered::

  • Hospital beds and routine mattress changes
  • Walkers, canes and crutches
  • Respiratory equipment
  • Patient lifts
  • Shower/bath chairs
  • Bedside commodes
  • Catheters, syringes, dressings and latex gloves
  • Incontinence supplies

Under Medicare law, no person will be refused hospice care due to inability to pay. AseraCare Hospice, a Medicare-approved hospice agency, has financial specialists on staff to answer your questions about receiving financial assistance. Funds may be available from donations, gifts, grants or other community sources to help cover the cost of care.

For additional information on Medicare's hospice care coverage, please read this 2-page excerpt from Medicare's 140-page booklet, "Medicare & You 2013."

 

Long Term Care

Medicare doesn't generally pay for long term care, or for help with activities of daily living including eating, bathing, dressing, and using the bathroom.

However, all states provide long term care services for individuals who are Medicaid eligible and qualify for institutional care. Please check the Medicaid section below for more detailed information.

 

Other Agency Programs

 

The following government programs also provide coverage for the types of healthcare services listed above. However, Medicaid and the VA have different eligibility requirements that we've outlined below.

 

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Medicare Part C, D and Medigap

Medicare Advantage or "Medicare Part C"

Medicare Advantage, sometimes called Medicare Part C, is another healthcare coverage choice you have as part of Medicare. These plans are offered by private companies approved by Medicare, and provide all of your Part A and B coverage except for hospice care. However, original Medicare will provide hospice care even if you are in a Medicare Advantage Plan.

For additional information on Medicare Advantage, please read this 11-page excerpt from Medicare's 140-page booklet, "Medicare & You 2013."

Medicare Part D - Medicare's Prescription Drug Coverage

To get Medicare's prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan varies in cost and the drugs covered.

For additional information on Medicare Plan D coverage, please read this 14-page excerpt from Medicare's 140-page booklet, "Medicare & You 2013."

Medigap - Medicare's Supplemental Coverage

Medigap policies are sold by private insurance companies. They help pay for some of the healthcare costs ("gaps") that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

For additional information on Medigap plans, please read this 4-page excerpt from Medicare's 140-page booklet, "Medicare & You 2013."

 

Medicaid

Medicaid is a program for eligible individuals and families with low incomes and resources that is operated jointly by the federal and individual state governments.

All states provide Long Term Care services for individuals who are Medicaid eligible and qualify for institutional care. For additional information on Medicaid's eligibility requirements and its long term care coverage, visit Healthcare.gov.

Eligibility requirements vary from state to state. To find out more about Medicaid in your state call the toll free number for your state. A list of toll free numbers can be accessed from this page at Medicaid's website.

 

U.S. Department of Veterans Affairs

Healthcare benefits like home health and long term care are only offered to certain veterans or to veterans under special situations.

  • Covers long-term care services for veterans, if the individual is at least 70-percent disabled due to a service-related injury or illness. A physician's authorization is necessary.
  • Covers home health care services for veterans, if the individual is at least 50-percent disabled due to a service-related injury or illness. A physician's authorization is necessary. 

For more information, visit the U.S. Department of Veterans Affairs.website.

 

Managed Care

 

If you have private insurance through your work or independently, you will need to check with your employer's benefits manager, or your insurance provider directly to find out what is covered under your policy. Plans vary widely on the healthcare services they cover.

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