Part A

While in a skilled nursing facility, Medicare Part A (Hospital Insurance) will pay for up to 100 days of skilled care, provided that the resident requires a daily skilled service as defined by Medicare guidelines and the admission to the facility is within 30 days of a three day or more hospital stay. For the first 20 days, Medicare pays 100% of the covered charges and for the next 80 days, Medicare pays all but $133.50 per day of covered charges, provided the patient continues to require skilled care.

Medicare Part A pays for the following services except when another payment source is primary:

• Semi-private room and board (excluding internal feeding)
• Specialized rehabilitation services: Physical, Occupational, and Speech Therapies
• Medications ordered by physicians
• Ancillary central supply items including certain special equipment such as air fluidized beds
• Oxygen, IV Fluids, Braces
• Personal laundry services

The following chargeable services are not covered by Part A if the patient should request them:

• Beauty and Barber shop services
• Telephone or Television
• Services provided at a physician office, Physician ordered consultations
• Private duty nurses or sitters
• Payment to hold bed when patient is hospitalized
• Services determined not to meet Medicare coverage criteria, and the patient has been notified in writing by the center

Part B

If the resident is not eligible for Part A benefits, the patient may receive services under Medicare Part B (Medical Insurance). Part B will pay for an unlimited time frame after the patient meets an annual deductible of $135.00. Part B pays 80% of allowable charges. Services covered include:

• Physician fees
• Specialized rehabilitation services when Part A is unavailable
• Physician ordered consultations
• Prosthetic items such as urological and internal feeding supplies

Part D

Medicare Part D helps pay for prescription drugs not covered by Medicare Hospital Insurance Part A.

How to Apply for Medicare

To apply for Medicare benefits, contact your local Social Security Office. The toll free number is 1-800-772-1213. You may also visit the Medicare website by clicking on the link, Medicare.

Medicaid

If a resident is approved for nursing home Medicaid, his/her charges are based on personal income. This amount is determined by the Department of Health and Human Services (DHHS).

The State Medicaid plan pays for following:

• Room and Board
• Specialized rehabilitation services
• Basic personal laundry services
• Payment to hold bed up to seven days when patient is discharged to the hospital

Services not paid for under the state plan include:

• Private room accommodations
• Beauty and Barber shop services
• Telephone and Television
• Private duty nurses and sitters
• Over the counter drugs not ordered by a physician

For more information about Medicaid and Medicaid Services, click on the link, Medicaid.