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Medicare

Medicare A Questions – 1-402-390-1850

Medicare B Questions – 1-800-633-1113

www.medicare.gov 

How Medicare Works:

Medicare services, Part A and Part B, are offered within the center to those who qualify for these services.

Medicare Part A (Original Medicare):  Medicare Part A can help pay for your care in a Medicare-participating skilled nursing facility if you meet all of these conditions:

       Your condition requires daily skilled nursing or skilled rehabilitation services which can only be provided in a skilled nursing facility and Medicare bed.

       You have been in a hospital at least three days in a row of acute care before being admitted to a participating skilled nursing facility.

       You are admitted to the facility within a short time, generally within 30 days after you leave the hospital.

       Your care in the skilled nursing facility is for the condition that was treated in the hospital.

       Two physicians certify that you need and you receive skilled nursing or skilled rehabilitation services on a daily basis.

There are many insurance plans similar to Medicare (Medicare Advantage, or private plans) that have different requirements for payment.  Understand your plan and how it affects your stay and financial responsibility.

Medicare A Coverage:

 Day 1 through 20                Medicare pays 100%

 Day 21 through 100            You are responsible for the co-insurance and  Medicare pays the remainder.*

 After Day 100                    You are responsible for all costs.*

*Some supplemental insurances will assist you in paying for co-insurance and other costs.  Know your plan and what it covers.

Once the resident is stabilized and their condition has reached the specific rehabilitation goal, the Medicare coverage of nursing home care expires and you will be notified of this change.  This daily rehabilitation goal will be monitored on a daily basis.  You will be notified of any change of your status in writing prior to this coverage being denied.

If you have exhausted your 100 day benefit period, you must have a 60 day spell of wellness before qualifying for another Medicare A/Skilled benefit period.

Medicare B Coverage:

Medicare Part B covers the services of doctor, supplies of medical items, and types of outpatient services such as physical therapy, x-ray, diagnostic testing and durable medical goods.  These items may be covered as long as they are ordered by a physician and you are not receiving Medicare Part A.

 Medicare will pay for 80% of approved charges after you have met a deductible.  You are responsible for the remaining 20% of approved charges as well as the yearly deductible.

Items or services, which are covered by Medicare Part B, will be billed to Medicare for the 80% and the resident will be billed for the remaining 20%.  All items to be covered must be reasonable and necessary according to Medicare guidelines in order to be billed – otherwise services over and above this would be billable directly to the resident.

Gold Crest Retirement Center complies with applicable Federal Civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.