Below is a list of online resources with links to informative websites that can answer questions typically related to rehabilitation, hospice care, respite care and skilled nursing care. Please visit these sites for information or contact your local Nexion Health affiliate.
- Texas Health and Human Services Commission
- Louisiana Department of Health and Hospitals
- Colorado Department of Health Care Policy and Financing
National or State Associations
- American Health Care Association
- Texas Health Care Association
- Louisiana Nursing Home Association
- Colorado Health Care Association
Medicare and Medicaid Benefits
Medicare and Medicaid do not pay for an unlimited amount of long-term care. We understand that these programs can be confusing; therefor, we provide below a general summary of the programs. These programs, their benefits and interpretation of their rules changes from time to time. For the particular circumstances involving you or a loved one, our affiliates have staff equipped to help you through the process of applying for Medicare or Medicaid coverage.
Medicare is an insurance program backed by the U.S. government for seniors more than 65 years of age, as well as people with specific disabilities. For medical treatment to be covered under Medicare, it must meet certain standards and be approved by a medical professional. Treatment must be provided by a Medicare-certified partner, like Nexion Health affiliated facilities, to be covered.
Medicare Part A:
- Part A pays all or part of the costs for inpatient hospital stays for up to 90 days. A patient pays a deductible upon admission to hospital and co-pay on days 61 through 90
- For skilled nursing facility treatment to be covered, a patient must have a hospital stay for a minimum of three nights and be transferred to a skilled nursing facility with 30 days of discharge.
Medicare Part A covers qualifying skilled nursing treatments for up to 100 days per benefit period, with the first 20 being paid in full by Medicare. The final 80 days require a co-pay. For benefits to regenerate, a patient must not receive skilled nursing treatment, in or out of a facility, for at least 60 consecutive days.
If a patient opts for hospice care in a qualifying Medicare program, Part A covers most of the cost.
Medicare Part B:
Part B requires a $124 deductible per year, along with payment of 20 percent of all Medicare approved charges beyond the deductible. Unless a person intentionally opts out, enrollment in Medicare Part B is automatic when a person enrolls in Part A. Premiums are required for coverage under Part B.
Part B pays the other 80 percent relating to:
- medical and surgical procedures the patient receives in a physician’s office, a hospital, a skilled nursing facility or at home;
- diagnostic tests and procedures related to treatment;
- the medical opinion of a second physician, when appropriate;
- services received in an emergency room or outpatient clinic;
- mental health care in a hospital outpatient setting;
- medically necessary ambulance transportation;
- qualified durable medical equipment (e.g., oxygen equipment and wheelchairs);
- outpatient physical, occupational and speech therapy; and
- other designated services.
Medicare Part D:
Part D covers prescription medications for those enrolled in Part A or B, with standard and low income plans for those on fixed incomes. Enrollment is not automatic like with Part B – a person must intentionally enroll in Part D if you want coverage. A co-pay, monthly premium and yearly deductible are required.
Medicaid is a state-administered program that differs from state to state. Medicaid pays for nursing coverage, if a person meets certain eligibility requirements set by the federal government. These include, but are not limited to:
- patient must be at least 21 year old;
- patient must be a U.S. citizen or resident alien;
- patient must have a medical need for nursing facility services, as noted by a qualified medical professional; and
- patient’s monthly income and countable assets must not exceed the eligibility limits set by the state;
As long as one meets the eligibility requirements, the patient continues to receive coverage.