Paying For Care
Call our Medicaid Coordinator for more Information!
We accept private pay, long term care insurance as well as most medical insurances including Medicare and Medicaid.
Medicare is a federal health insurance program for people over 65 and certain disabled people under 65. It is not a long-term care program. Rather, Medicare covers only those nursing facility services rendered to help a beneficiary recover from an acute illness or injury. Medicare is administered by the federal government's Center for Medicare and Medicaid and is divided into two parts: Hospital Insurance (Part A) and Medical Insurance (Part B).
How are Payments made?
Payments are made to providers through private insurance companies with which the government contracts or through HMOs who have risk contracts with Medicare. Eligibility -- Nursing facility coverage falls under "Part A" of Medicare and is very limited. Medicare pays up to a total of 100 days of car in a skilled nursing facility (SNF).
Medicare will cover 100 percent of the first 20 days in a SNF; for days 21-100, the individual must make a daily coinsurance payment.
Medicare Pays for Nursing Facility Care only under the following Conditions:
- The nursing facility is a skilled nursing facility (SNF). SNFs provide 24-hour nursing care to convalescent patients.
- Continuous skilled nursing care or skilled rehabilitation services (as defined but eh federal government) are required on a daily basis.
- The Patient has spent at least three consecutive days in a hospital and if the admissions to the SNF occurs within 30 days after discharge from the hospital.
- A physical certifies that SNF Services are needed for the same or related illness for which the person was hospitalized.
What are the Benefits of Medicare?
If all the conditions above are met for Medicare:
- Medicare will pay for the cost of care during the first 20 days of care in a SNF.
- For the 21st through the 100th days, the patient must share the cost of care by paying a daily coinsurance rate, or a Medicare supplement can pay it. For 2022, the coinsurance amount is $000 (this changes annually).
What Services are Covered under Medicare?
- Semi-Private Room
- Meals (including special diets)
- Regular Nursing Services
- Rehabilitation Services
- All Drugs
- Medical Supplies
What is NOT covered under Medicare?
- Personal Convenience Items
- I.E. Telephones
- Beauty/Barber Shop etc.
How do I Apply for Medicare?
Contact your Social Security office to find out if you are automatically covered for Part a because of credits for number of quarts worked in your lifetime. Also, if you are interested in signing up for Medicare Medical Insurance (Part B), the Social Security office can assist you with that process as well. Keep in mind, you can only sign up for the insurance in the first three months of the calendar year.
Medicaid is a cooperative federal-state program designed to provide assistance to low-income people. It has become the major funding source for long term care. Medicaid is administered by the states under broad federal guidelines. Reimbursement rates per day of care are also set by the states.
Benefits -- Medicaid will pay for care in a nursing facility (NF). The amount paid is determined by the State of Texas and covers room, board, and nursing care. Medicaid will determine the amount to be paid by the resident/responsible party.
Applying for Medicaid -- Contact your local Texas Department of Human Services for an application. Because Medicaid is based on financial need, you will be asked for information such as residence, family composition, income, real and personal property, and medical expenses. You will also need to be sure that the nursing facility which will be receiving payment is Medicaid "Certified".
Risk of Impoverishment -- Spouses of nursing facility residents are protected from what is termed "spousal impoverishment". This refers to the required depletion of an "at-home" spouse's financial resources so that the spouse in the nursing home can qualify for Medicaid.
Beginning September 30, 1989, states were required to permit the at-home spouse to retain a "Maintenance needs allowance" from the other spouse's income sufficient to bring the at-home spouse's income to 150 percent of the federal poverty level for a two-person household.
Because many Americans fail plan for their long-term care needs, tens of thousands of Americans are impoverished each year by the costs of long term care. Recently enacted health insurance legislation has helped make private long term care insurance a more viable option to pay for long-term costs while preserving personal savings.
The Health Insurance Reform Act includes consumer protections for purchasers of long-term care insurance and tax clarifications for long-term care insurance which make treatment of private long-term care insurance identical to that of health insurance coverage. Starting January 1, 1997, individuals have been able to include out-of-pocket expenses of long-term care and long-term insurance premiums with their other itemized medical expenses on their annual tax returns. Long-term care and other medical expenses are deductible, provided that they exceed the federal government's 7.5 percent threshold of adjusted gross income. Also, the insurance benefits consumers receive, for the most part, will not be taxable as income.
Supplemental Security Income (SSI)
SSI is a monthly cash payment from the government for eligible individuals in financial need who are aged 65 or older or personal who are blind or have a disability (including children). Typical, a person eligible for SSI payments has little or no income, total assets of les than a few thousand dollars (within certain limits set out in regulations, not including a home used for self-support, automobile, values of household good, personal effects, and life insurance), has U.S. citizenship or qualified alien status, and U.S. residency.
In certain circumstances, the SSI payment may be used towards some housing and care needs of the individual.
The SSI program is run by the Social Security Administration (www.ssa.gov), but the SSI is not the same as Social Security. Money for SSI payments come from the general fund of the U.S. Treasury, and some states add money to the federal payments.