FACTS YOU SHOULD KNOW:

Medicare does not pay for continual nursing home care (only rehab care and only if you improve).

You can use your own funds to pay for nursing home care and still be forced to leave other facilities when the money runs out.

Not all facilities accept Medicaid, and some have very few Medicaid beds that may not be available when you need them.

This will NEVER happen to you at       Autumn Woods. We will maximize your benefits and make sure you receive uninterrupted coverage.

ASK BEFORE YOU ACT
We cannot emphasize enough how important it is to ask questions before you make your decision about placement or rehab.

Our goal is to make sure that you receive the uninterrupted care you deserve.  We will never misrepresent ourselves.  Ask questions at any facility before you’re admitted.

Medicare
Medicare benefits are rehabilitative benefits (not long-term care benefits). The maximum amount is 100 days. Medicare only pays fully for 20 days, your co-insurance will assist from day 21 through day 100, assuming you qualify for the entire benefit.

After a hospitalization of at least 3 days, Medicare will help pay for you to get better whatever your problem is. For example, if you broke your hip, they help pay for rehab, if you had pneumonia, they pay for you to get up and about, if you had a stroke, they pay to show you how to feed and take care of yourself again.

When you have reached your maximum potential according to the therapists, your Medicare benefits end and no longer pay for any type of care.

Medicare Co-Insurance
Because Medicare has deductibles and doesn’t cover 100% of your health care costs, most people carry a co-insurance to cover these deductibles. Each policy is very individual and specific as to how much rehab it actually pays for. These co-insurances begin on day 21 when your full Medicare coverage ends. Some of these co-insurances are highly limited and require pre-authorization for their use.

The co-insurance is limited to rehab only, just like Medicare. Once you’ve reached your potential, the coverage ends with your Medicare coverage.

What Happens Next?
Either you are well enough to go back home or into the community or you will be admitted as a long-term resident.

Who Pays for it Now?

Private Funds – if you have savings or private funds, you will have to use those funds to pay for your care. This is where your choice of facility has become very important.

Some private pay facilities can take all of your private funds no matter how much you have and ask you to leave when your money is gone. These are Medicare facilities that are not certified for Medicaid. You can also go to a facility that will tell you that they have “Medicaid” beds but those beds are very limited and always full.

A facility can be Medicare and Medicaid certified but still have limited Medicaid beds. ASK if all the beds are certified for Medicaid. This will assure an uninterrupted stay at the facility.

Medicaid
Medicaid is welfare. You must have almost no savings and meet specific criteria as mandated by the state of Michigan to qualify for Medicaid benefits. Medicaid pays the entire bill for long-term care services with the exception of pension and social security, which must be paid directly to the facility as mandated by the state program. Each person’s “Patient Pay Amount” differs depending on their income. This is set by the state. Your Medicaid coverage includes all services such as pharmacy, doctor visits and testing, but no rehab, as the rehab benefit is Medicare.

There is a long complicated application for Medicaid that must be completed and turned in to the state office before coverage can be initiated. You must deplete you private funds prior to Medicaid becoming effective.

ASSISTANCE IS AVAILABLE
Our professional and knowledgeable staff will help you complete the insurance information and Medicaid application, turn them in to the office and make sure your coverage is initiated to avoid an interruption in care.

 

 

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