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There are a number of methods of payment for long-term care services. The following information has been compiled to clarify the eligibility requirements and benefits of each and to help you determine which source best suits your needs.
MEDICARE
Medicare is a federal health insurance program for people age 65 or older and people under age 65 with certain disabilities.
Part A (Hospital Insurance)
Medicare Part A helps cover the cost of care in a Skilled Nursing Facility (SNF) for a specific benefit period (up to 100 days) if:
The person has been in a hospital for at least three consecutive days; the person has been admitted to the facility within 30 days of leaving the hospital, and; a physician certifies that skilled nursing or rehabilitation services are needed on a daily basis.
Medicare fully covers the first 20 days of the benefit period. There is a $124 per day co-payment for days 21-100, which is paid by the resident, their supplemental insurance or Medicaid (if approved). Once the benefit period expires, the payment source converts to one of the others described below.
Covered Items and Services
Payment through Medicare Part A includes nursing services, therapy, room and board, bed linens, incontinence supplies, routine laundry services, regular meals and snacks, social services, activities and personal hygiene items.
Part B (Medical Insurance)
Medicare Part B typically helps cover the cost of doctor's services and outpatient care, but in a long-term care setting pays for some physical, occupational and speech therapy when they are considered medically necessary.
MEDICAID
Medicaid is a state-administered health insurance program that covers long-term care for low-income elderly and disabled people.
Eligibility
In order to apply for long-term care Medicaid, one must meet the following criteria:
Age 65 or older or disabled;
United States citizen, and;
Reside in Louisiana.
Additionally:
Monthly income may not exceed $2,022 for an individual and $4,044 for a couple if both need long-term care services; countable resources cannot be worth more than $2,000 for an individual or $4,000 for couples that both need long-term care services. Resources include cash, stocks and bonds, land and anything else that could be changed to cash. If a resource is sold, given away, or transferred for less than fair market value within the 36 months before or at any time after applying, Medicaid may presume it was done in order to qualify and that person may not be eligible for their financial assistance. Couples may have $109,560 in resources for 2009 if one spouse remains at home.
Under Spousal Impoverishment rules, individuals applying for long-term care services may give some of their income to a spouse who still lives at home. Contact the local Medicaid office at (337) 898-2854 for further information.
Our facility will initiate the Medicaid application process. The Medicaid Program, however, determines whether or not it will pay for the nursing facility care and services we provide to you. In most cases, Medicaid will make an eligibility decision within 45 days.
Patient Liability
If one qualifies for Medicaid benefits, that person may be required to contribute Social Security and/or pension income to the cost of care and services as determined by the Medicaid Program.
If the Medicaid application is denied, the full cost of services from the date of admission (room, board, meals, medication, etc.) becomes the resident's responsibility.
Covered Items and Services
Payment through the Medicaid Program includes nursing services, therapy, room and board, bed linens, incontinence supplies, routine laundry services, regular meals and snacks, social services, activities and personal hygiene items.
PRIVATE PAY
The full cost of services (room, board, meals, medication, etc.) may be paid entirely from private funds. We will not at any time prohibit anyone from applying for Medicaid program benefits and, thus, will not require anyone to remain in private pay status for any period of time. It is imperative, however, that the resident or resident's family inform our social services director before personal funds will no longer be available so that we may assist in applying for financial assistance.
LONG-TERM CARE INSURANCE
Long-term care insurance is a private insurance policy that can help pay for many types of services, both skilled and non-skilled. Since coverage can vary widely, policy provider must be contacted for more details.
VETERANS ADMINISTRATION
Only veterans can apply and qualify for assistance.
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