Paying for Care
Medicare and Medicaid are government funded medical insurance programs. Each program pays for some, but not all services provided in a skilled nursing center. Individuals who do not have these or other insurance plans can pay directly for their room and board and any ancillary services provided. Payments can be made by direct deposit, check or credit card.
It is important to know what your insurance covers in order to understand your responsibility for payment.
Medicare
Medicare is available once you turn 65 years old. Some people have original Medicare while others opt for a Medicare Advantage plan. Both plans cover short-term rehab stays in a skilled nursing facility, up to 100 days after a qualifying hospital stay. Medicare does not cover assisted living or long term care in a skilled nursing center.
Medicare and You is a guide posted on the CMS Website that provides details regarding Medicare. Specific sections of interest to you may include:
- How Does Medicare Work page 15
- Skilled Nursing Facility Coverage page 33
- What Medicare Does Not Cover page 59
For further guidance on Medicare call 1-800-MEDICARE or visit www.Medicare.gov. Center team members can also answer questions about Medicare coverage.
Medicaid
Medicaid is a program designed by states to support individuals who need financial assistance to pay for medical care. Each state has its own guidelines as to what services Medicaid pays for in a skilled nursing facility.
The Medicaid application process is extensive. If you are considering a long-term stay for yourself or a family member, center admissions staff members are happy to provide you with additional information and assist you with the application process.
Insurance
We realize that many of you may have insurance coverage other than traditional Medicare or Medicaid. Our client centers participate with many Medicare Advantage, commercial (employer based), and individual Insurance Exchange health plans. Contact your desired center to determine if the center is in your health plan’s network. The center will work on your behalf to obtain “In-Network” or “Out of Network” authorization from your plan and give you information related to coverage details and “out of pocket” costs (if any).