Medicare is a Federal Healthcare Insurance Program for people that are 65 years or older or people under 65 with certain disabilities or end-stage renal disease.
Medicare Part A
Medicare Part A helps pay for hospital stays, skilled nursing facility care, and hospice care. In a skilled nursing facility, Medicare Part A covers up to 100 days of a “Benefit Period” as long as the individual has met specific criteria, including:
- A qualifying 3 night stay in a hospital
- Admission to a Skilled Nursing Facility for reasons/skilled care within 30 days of discharge from a hospital.
Medicare Benefit Period
An individual qualifies for 100 days of coverage if no skilled care has been provided within the last 60 days – i.e., no acute care hospital stay or Medicare SNF (Skilled Nursing Facility) days (some hospitals have skilled beds), or skilled days used in a prior facility. If a resident has used SNF days in a hospital or another skilled facility, those days would need to be subtracted from the 100 day allotment to determine how many days the individual has remaining.
Medicare Co-Pay or Co-Insurance
This is the amount established yearly by Medicare. This is the amount per day after day 20 that Medicare does not cover and is the individual’s responsibility.
Medicare Eligibility in a Skilled Nursing Facility
- The individual must have Medicare Part A benefits and been in hospital for three consecutive (inpatient) overnights in an acute care hospital.
- The individual requires skilled nursing services or skilled rehabilitation services by a licensed professional.
- Services must be pursuant to a physician’s order stating individual requires daily skilled care.
What services does Medicare cover?
- Rehabilitation services including physical, occupational, and speech therapies
- All meals, including dietary consult and special diets
- Nursing Care
- Medical Supplies
- Special Equipment
30 Day Window
An individual can utilize their Medicare benefits within 30 days of discharging from the hospital.
For instance, if an individual decided to discharge home but realized after a few days that a better option would be to go to a rehab nursing facility to recieve therapy. This option is available up to 30 days from the day the patient discharged from the hospital.
Medicare Part B
Medicare B assists in covering medically necessary doctor’s services, outpatient care, home health services, durable medical equipment, and some preventative services.
Medicare Part D
Medicare D is the prescription drug plan. Plans vary in cost and coverage so it is important to choose a plan that is best suited to meet an individual’s needs.
What happens when Medicare coverage ends?
If an individual would like to remain at our facility once coverage ends, please Contact Us so we can meet with you and discuss payment options at The PARC at Joliet. The PARC at Joliet can accommodate long-term custodial care as well as assist in applying for Medicaid.