Payment Topics

Medicare

What is Medicare?

Medicare is health insurance paid by the federal government for people age 65 or older, under age 65 with certain disabilities. Medicare has multiple benefits that include Medicare Part A, Part B, Part C, and Part D.

Who Is Eligible For Medicare?

To be eligible for home health care under Medicare:

• You must be covered by Medicare
• You must have a need for skilled services in the home such as nursing, physical therapy or speech therapy
• You must be under the care of an attending Medical Doctor (M.D.), Doctor of Osteopathy (D.O.), or Podiatrist (D.P.M.) who signs orders for home care
• You must be essentially homebound, requiring reasonable and taxing effort to leave home

How Do I apply For Medicare?

Via application.

What Does Medicare Cover?

Patients are eligible for 100 days of Medicare Part A coverage during a benefit period and as long as the patient is medically necessary. The first 20 Medicare days are paid in full (100%) by Medicare Part A for charges related to a Medicare Part A stay. The remaining 80 days are referred to as Medicare co-insurance days. This means Medicare Part A will pay for all Medicare related charges for the next 80 days except for the co-insurance amount. 

Medicare Advantage

What Is Medicare Advantage?

Medicare Advantage is a plan that was designed by the Federal Government to allow Medicare beneficiaries to purchase their Medicare Benefits from commercial health insurance companies. Medicare Advantage is also referred to as Medicare Part C

Will It Cover My Health Needs?

If you sign up for a Medicare Advantage plan, it is important to review the coverage available in all categories of service, such as Physician Services, Long Term Care, and Post-Acute Care (Skilled Nursing Facilities, Home Health Care, Hospice Care, etc.) Medicare Advantage plans are required to offer health benefits that meet or exceed the benefits offered by traditional Medicare, but they do not have to pay for each service in the same way.

How Much Will I Have To Pay?

When you sign up for private health insurance, remember to consider all out of pockets costs, such as the deductible and all copayment requirements for each category of service. Make sure you review your Evidence of Coverage document, which will explain all your plan benefits and costs. You should receive your Evidence of Coverage document when you sign up for your plan, but you can also find it on your company’s web site or by calling the insurance company to request it. With all the private insurance plans available, you should be able to choose one that makes sense for your financial situation.

Medicaid

What Is Medicaid?

Medicaid is an assistance program funded jointly by the federal and state governments and administered by individual states.

Medicaid eligibility is based on income level, assets, and resources.

Who Is Eligible For Medicaid?

In general, you are eligible for Medicaid if your income is low and meets your states requirements and you match one of the following characteristics:

• Over the age of 65 or a child under the age of 18
• You are pregnant
• Breast or cervical cancer diagnosis
• You require nursing home care
• You are blind or have a disability

How Do I Apply For Medicaid?

When applying for Medicaid, you will need to speak to a representative at your local Department of Family and Children Services (DFCS) office. You must submit a signed application to DFCS.

When you begin the application process, it will be useful to have these documents with you.  Having these documents prepared beforehand will allow the application process to move more quickly.

• Proof of identity and citizenship (birth certificate or certified birth certificate)
• Federal or state identification cards
• Social Security Number
• Payroll records or paycheck stubs for the last four weeks.
• Proof of any income from such sources as Social Security, retirement, pensions, unemployment
• Current health insurance information
• Life insurance policies
• Any recent bank statements
• Documents showing any land you may own

What Does Medicaid Cover?

There are some limitations on services that you can receive through Medicaid, but generally Medicaid covers the following services:

• Visiting a doctor or nurse for checkups, lab tests, exams, or treatment
• Prescription drugs
• X-rays
• Inpatient and outpatient hospital services
• Nursing facilities
• Emergency ambulance services
• Transportation services to get you to a doctor’s visit
• Medical equipment and supplies prescribed
• Home health services prescribed by your personal physician
• Hospice care
• Dental care

Private Insurance

What Is Private Health Insurance?

Private health insurance is coverage that is purchased from a private (or commercial) health insurance company.  Private Health insurance is the largest source of health insurance coverage for Americans.  Most people purchase their health insurance coverage through their jobs, sharing the cost of premiums with their employer, but many purchase their coverage individually.

Who Much Will I Have To Pay?

When you sign up for private health insurance, remember to consider all out of pockets costs, such as the deductible and all copayment requirements for each category of service.  Make sure you review your Evidence of Coverage document, which will explain all your plan benefits and costs.  You should receive your Evidence of Coverage document when you sign up for your plan, but you can also find it on your company’s web site or by calling the insurance company to request it.  With all the private insurance plans available, you should be able to choose one that makes sense for your financial situation.

Will It Cover My Health Needs?

There are numerous private insurance companies that offer many types of benefit plans.  When you sign up for a private health insurance plan, it is important to review the coverage available in all categories of service, such as Physician Services, Long Term Care, and Post-Acute Care (Skilled Nursing Facilities, Home Health Care, etc.)  Make sure the plan you choose make sense for your health needs.