Medicare Explained

Medicare is government health insurance for people age 65 or older, people under 65 with certain disabilities and people of any age with End Stage Renal Disease. The eligibility requirements and benefit structure are the same nationwide. In most instances, if you paid into the Social Security or Railroad Retirement system, you are eligible for Medicare at the start of the month you turn 65. If you are under 65 and receiving disability benefits from Social Security or Rail Road Retirement, you might automatically receive Medicare A and B. To access benefits, your medical charges must meet federally established Medicare standards. Further, Medicare certified providers such as hospitals and other health care providers must deliver the services you receive. Heritage Convalescent Center, a Skilled Nursing Facility, is a Medicare certified provider. For more information about your Medicare benefits, refer to your most current Medicare and You handbook or visit Medicare on the Web at www.medicare.gov or call 1-800-633-4227.

The Medicare program has three components:

  • Part A is inpatient insurance. For example, hospital or skilled days services.
  • Part B is out patient insurance . For example, physician visits; out patient rehabilitation; diagnostic services.
  • Part D is a prescription drug insurance. Medicare offers prescription drug coverage to everyone with Medicare. Part D is prescription insurance that adds drug coverage to Original Medicare and other select Medicare plans.

In-Patient Care in a Skilled Nursing Facility – Medicare A pays for care in a Skilled Nursing Facility. To be covered under Medicare A, you must have had a minimum three-midnight hospital admission and enter a Skilled Nursing Facility within 30 days of discharge from the hospital. In most cases, the first 20 days of stay are covered 100% by Medicare A. For days 21-100 of continuous stay, Medicare A pays 80% of the cost leaving a Federally set out of pocket cost to the beneficiary. Medicare A and your supplemental insurance might cover days 21-100, commonly referred to as co days. If your Medicare supplemental insurance does not cover co days in a Skilled Nursing Facility, you might be responsible for these charges. No benefits are provided after day 100. Part A does not pay for your stay in a Skilled Nursing Facility if you need skilled nursing services or rehabilitation services less than daily or if these services are no longer improving your condition.

Medicare does not pay for long-term care. Individuals who need assistance with activities of daily living such as dressing, bathing, grooming, eating and toileting, but have not had the required three midnight hospital admission, cannot use Medicare A to pay for care in a nursing home. Heritage Convalescent Center participates in the Medicaid program. Medicaid can pay all or most of the cost of your care if you apply for and qualify.

For more information, please call our Admissions Coordinator at (806) 352-5295.