Medicare Part A, How does it work?
Medicare A is a federal health insurance program for people age 65 or older or those who have been determined to be disabled for over 2 years. In a nursing facility, Medicare A pays based on Medical Need. In order for Medicare A to pay for a stay in a long term care facility, a three midnight, in-patient, hospital stay is required. Medicare admissions are generally immediately following the hospital stay but at times individuals return home from the hospital and then find they need to enter the nursing facility. This admission from home is still covered by Medicare A, if the hospital stay was no longer than 30 days prior. With traditional Medicare A, the first 20 days is covered at 100%. Days 21-100 require a co-payment through a Medicare Supplement or paid privately.
Medicare Part B, How does it work?
Medicare B is a federal health insurance program for people age 65 or older or those who have been determined to be disabled for over 2 years. This program allows for residents to receive therapy if their stay is not covered by Medicare A. Medicare B also covers outpatient therapy, labs, x-rays, flu and pneumonia vaccines and certain medical supplies. A 20 % co-payment from a Medicare supplement policy is often required. Medicare B has a deductible. Please ask our Office Manager for the current rate.
What is needed to apply for Medicaid?
Medicaid is a federal and state funded medical assistance program. Medicaid pays based on financial need. First, an application needs to be completed on line, by telephone, or in person at a Medicaid office. Once the application is submitted, a list of information is provided and must be gathered by the responsible party and sent in to Medicaid. Each Miller’s facility has a business office manager to assist in sending this information. Medicaid will follow up with a call to determine eligibility.
If my loved one qualifies for Medicaid, what will their liability be and how much can they keep
A resident will be able to keep $52.00 of their monthly income.
Am I eligible for Medicaid for LTC?
Medicaid is a federal and state funded medical assistance program. Medicaid pays based on financial need. An application would need to be completed on line or in person at a Medicaid office. For an individual, the amount of assets that are allowed are $1500. This amount includes all assets such as checking, savings, 401K, CD’s, Retirement Accounts, Life Insurance, House, Car, etc. For a couple, the information is provided under spousal impoverishment. There are elder law attorneys that specialize in Medicaid information and application as well as each Miller’s facility has a representative that will help with Medicaid application.
What is Managed Care?
Managed care occurs on certain medical plans in which access to healthcare services is managed with the goal of quality care at the lowest possible cost. Some examples of Managed Care are HMO’s and PPO’s. With managed care, the financial risk is shifted to the provider.
What are spousal impoverishment qualifications for Indiana Medicaid?
When a resident is admitted with a spouse continuing to live outside the nursing facility, there are benefits that can be applied for through the Medicaid program. The spouse at home is able to keep the car and home as well as half of the combined assets with set minimum and maximum limits.
What does the room charge include?
The room charge includes 24 hour nursing care, meals, housekeeping, laundry, social services, activities, billing services, therapeutic diets, personal services and care planning. Additional charges would include: medications, personal and medical supplies, personal clothing, eyeglasses, dentures, hearing aids, labs and x-rays, beauty shop, cable TV, phone, and therapy services. Some of the above items are included if the resident is covered under Medicare, Medicaid or insurance.
As an adult child, do I need POA over my parent?
Power of Attorney and Health Care Representative papers are not required but are good to have in place should the resident's health change and prohibit them from signing at a later date. Power of Attorney is generally for financial decisions while Health Care Representatives allows for medical decisions to be made as well. In some cases, if the resident is unsafe to make decisions and deemed incompetent to sign POA, Guardianship may be required and is done through an attorney and the court system.
When do rate changes occur?
Rate changes occur annually around November 1. Advance notice of 30 days is provided and the amount of the increase varies per facility.
Will I be required to give an advanced payment?
No advance payment is required of residents whose stay will be covered by traditional Medicare. Some insurance policies and Medicare Replacement plans require a co-payment. If a co-payment is required upon admission or if the resident is private pay, an advanced payment would be required. Generally a 30 day advanced payment is required with exceptions on occasion. If the resident stay is being paid by Medicaid, the resident’s liability or spend down amount may be owed to the facility upon admission.
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