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Important Information You Need to Have About Your Medicare Benefits

As They Relate to Skilled Nursing Facilities

Medicare Coverage - Part "A"

When all program requirements are met, Medicare Part A Helps pay for:


Inpatient Hospital Care

Medicare Part A covers a semi-private room, meals, general nursing, and other hospital services and supplies. This does not include private duty nursing, a television and a telephone in your room. It also does not include a private room, unless medically necessary. In-patient mental health coverage in a n independent psychiatric facility is limited to 190 days in a lifetime.

For Medicare Part A hospital benefits, those who qualify must pay a deductible. This fee is paid just once during a benefit period, even if you're in and out of the hospital several times. During any given benefit period, 60 days is the longest you can remain in the hospital without any additional charges. If, during that same benefit period, you remain in the hospital for up to an additional 30 days, you would then be required to pay a daily co-payment for days 61 through 90.

Starting on the 91st day, you may begin to draw on a "lifetime reserve", which is a 60 day, non-renewable buffer. While using this reserve, you must pay a daily co-payment of $406. You may choose to not use your lifetime reserve, in which case you become responsible for all payments in full. Under this program, inpatient hospital coverage would include a semi-private room, meals, diagnostic tests, medications, and standard nursing care.

Skilled Nursing Facility Care

Following a 3 day stay in a hospital, and after being discharged from the hospital you need to go to a skilled nursing facility, Medicare Part A covers services for a semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies. 

Medicare will help pay for your care for up to 100 days in a benefit period so long as the services provided are either skilled nursing and/or skilled rehabilitation required on a daily basis.

Part A pays the full cost of covered services for the first 20 days. All covered services for the next 80 days are paid by Medicare except for a daily co-insurance amount. You are responsible for paying the co-insurance. IF you require more than 100 days of care in a benefit period, you are responsible for all charges beginning with the 101st day.

What happens if you discharged from a skilled nursing facility and later must be readmitted? IF you are still in the same benefit period, Medicare will continue to help pay for your care until you have used up your 100 days of coverage. The care must be for a condition treated during your previous stay.

IF you have been out of the skilled nursing facility 60 or more days and the benefit period has ended, another three-day hospital stay will be required before your skilled nursing facility care benefits are renewed.

A benefit period begins the day you are admitted to a hospital. It ends when you have been out of a hospital or skilled nursing facility for 60 consecutive days. It also ends if you are in a skilled nursing facility but have not received skilled care there for 60 consecutive days.

The next time you are admitted to a hospital, a new benfit period begins and your hospital and skilled nursing facility benefits are renewed. There is no limit to the number of benefit periods you can have. If you have questions about the benefit period, please visit with the Administrator.

Home Health Care

Medicare Part A pays for part-time skilled nursing care, physical therapy, occupational therapy, speech therapy, home health aid services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and supplies, and other services.

The patient must be home bound to receive such services. The patient pays nothing for home health services and 20% of the Medicare approved amount for any durable medical equipment they may need.

Hospice Care

Medicare Part A pays for medical and support services from a Medicare-approved hospice, drugs for symptom control and pain relief, short-term respite care, care in a hospice facility, hospital, or nursing home when necessary, and other services not otherwise covered by Medicare.

The patient is required to pay a co-payment for outpatient prescription drugs and 5% of the Medicare approved payment amount for in-patient respite care (short-term care given to a hospice patient by another care giver, so that the usual care giver can rest). The amount you pay for respite care can change each year.

Medicare Coverage - Part "B"

Medicare Part B provides a means for additional services to be provided that Medicare Part A does not cover. Medicare Part B helps pay for Physician Services, Outpatient Hospital Care, Outpatient Therapies (physical, occupational, and speech), Prosthetic Devices, Clinical Laboratory Services, Radiology Services, Blood, and preventative services. These preventative services include: Bone Mass Measurements, Colorectal Cancer Screening, Diabetes Services, Mammogram Screening, Pap Smear and Pelvic Examination, Prostate Cancer Screening and Vaccinations for the flu, pneumonia, and Hepatitis B. Part B will typically pay 80% of the approved amount for these services and supplies when they are medically necessary.

Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit you local Social Security office, call the Social Security office, or call the Social Security Administration at 1-800-772-1213 to sign up. If you choose Part B, the premium is usually taken out of your monthly Social Security payment. If you do not receive a monthly social security check, Medicare sends you the bill for your Part B premium every 3 months. You should get your Medicare premium bill by the 10th of the month. If you do not get your bill by the 10th, call the Social Security Administration at the number listed above.

What is not paid for by Medicare Part A and Part B?

Medicare does not pay for everything. Your out-of-pocket costs for health care will include, but are not limited to:

• Acupuncture.

• Deductibles, co-insurance, or co-payments when you get health care services.

• Dental care and dentures (in most cases).

• Cosmetic Surgery.

• Custodial care (help with bathing, dressing, toileting, and eating at home or in a nursing home).

• Health Care you get while traveling outside of the United States (except in limited cases).

• Hearing aids.

• Orthopedic shoes.

• Outpatient prescription drugs.

• Routine foot care.

• Routine eye care.

• Routine or yearly physical exams.

• Vaccinations (except flu, pneumonia, and Hepatitis B).

• Your monthly Part B premium.