Hospital Insurance – Part A:
Part A covers care provided by a Medicare skilled nursing facility to help a beneficiary recover from an acute illness or injury. Medicare provides full coverage for the first 20 days of care in a skilled nursing facility and a portion of the costs for skilled nursing facility care for days 21–100. During this period, the patient pays a daily coinsurance rate. Any Medicare A stay requires a 3–day hospital stay within 30 days of admission to a skilled nursing facility.
Medical Insurance – Part B:
Part B is a supplemental program for which you must pay an annual premium and a deductible for all covered services, including physician services. Part B coverage relates to ancillary services such as physician services, lab work, x-rays, and therapy. In some cases, Part B may cover short-term services such as physical or other therapies within an assisted living facility. After meeting the deductible, Part B pays 80 percent of the reasonable charges for covered services only. Part B may pay for covered services you receive from your doctor while in a skilled nursing facility from the time of admission.
For qualifying individuals, Medicaid pays for services in a certified Medicaid skilled nursing facility or non-skilled facility. In many states, Medicaid will pay for assisted living services, although coverage is limited. You must meet a state-determined financial limit along with certain health criteria. Medicaid is also the primary payer of services for persons with mental retardation and developmental disabilities.
Private, Supplemental or Long-term care Insurance
Insurance coverage is available to cover certain costs of nursing facility care. Some plans will supplement Medicare or Medicaid coverage and cover expenses beyond what these plans cover. Others pay for a portion of the daily expense for a set amount of days in a nursing facility. If you or your family member has such insurance coverage, bring the policy to the attention of the nursing facility. You can then work with our administrative staff and discuss how to file claims to receive the best benefits.
Bartley accepts VA benefits, should you need assistance please give us a call.