Navigating through insurance benefits, replacement plans, HMOs, coinsurances and elimination periods is no simple task. Luckily, Carillon has experts available to walk you through the process and help verify the benefits for each and every situation. Start here for the basic information, visit the resource websites provided, or give us a call!
Medicare Part A (hospital insurance) covers skilled nursing care under certain conditions for a limited time. Covered services include, but aren’t limited to, a semi-private room, meals, nursing care, certain therapies (if they’re needed to meet your health goals), social services, medications, medical supplies and equipment, and dietary counseling. A patient is eligible for coverage if he/she has Medicare Part A, days left in the benefit period, a qualifying hospital stay, and doctor’s orders for daily skilled care and/or rehabilitation services.
The benefit period begins the day you are admitted to a skilled nursing facility (SNF) and includes up to 100 days of coverage. This 100 days is not guaranteed, and depends the individual’s health goals. If a patient meets the goals or reaches a plateau at day 37, for example, the in-patient SNF coverage could end at day 37. The full benefit period ends after a 60-day period of wellness, during which the patient does not receive in-patient hospital or SNF care. Thereafter, the patient is eligible for a new benefit period, and there’s no limit to the number of benefit periods one can receive.
During the benefit period, Medicare covers 100% of the costs from days one to 20. During days 21-100, Medicare covers 80% of the cost, and the remaining 20% coinsurance ($167.50 per day) can be billed to the patient’s supplemental insurance. Coinsurance coverage and benefit varies based on the provider (Blue Cross Blue Shield, Humana, Aetna, etc.).
A qualifying hospital stay is defined as three days inpatient care. Time that one spends as an outpatient or under observation doesn’t count toward the 3-night hospital stay. The patient must enter the SNF within a short time (usually 30 days) and require skilled services related to your stay.
If you have additional questions, please visit The Official U.S. Government Site for Medicare’s website, and follow this link for specifics on SNF care. Or, talk to one of Carillon’s Medicare experts by calling 806-281-6114.
Medicaid provides health coverage to low-income seniors, nearly all of whom are also enrolled in Medicare. Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid. Medicaid also covers additional services beyond Medicare, including full nursing facility care beyond the 100-day-limit of skilled nursing facility care.
Please visit www.Medicaid.gov for more information on the 2018 dual eligible standards, which are based on a percentage of the federal poverty level. Carillon is not a Medicaid-certified facility, but we are happy to help direct you to other quality providers.
Long-Term Care Insurance
Long-term care insurance helps pay for costs associated with long-term care that are general not covered by Medicare, Medicaid or supplemental health insurance. The covered services and supports could include personal and custodial care in a variety of settings, including your home, Life Plan Community, or other facility.
These policies reimburse policyholders a daily benefit amount (up to a pre-selected limit) for services to assist with activities of daily living, including dressing, bathing, or eating. Different policies provide a variety of care options and benefits that provide financial assistance to get the services you need, when you need them. If you are in poor health or already receiving long-term care services, you may not qualify for this type of insurance.
The cost of a long-term care policy is based on your age, the maximum daily benefit, lifetime maximum benefit, and any optional benefits you choose, such as benefits that increase with inflation. For example, some policies may provide for a $50 day maximum benefit for up to 4 years, and others may offer a $100 per day benefit with a $200,000 maximum benefit. Before you purchase a policy, be aware that the insurance company may raise the premium on your policy. Always request the company’s rate histories before finalizing the purchase.