Questions and Answers
If
you have a question that is not answered in this section,
please call Jenkins
Living Center at (605) 886-5777 or
e-mail your question to
Administration.
Will Medicare pay for my stay in a
nursing facility?
The long-term care benefit under Part A of the Medicare
program consists of up to 100 days of coverage in a nursing
facility. Eligibility is not automatic and, in fact,
requires that some very specific criteria be met. First of
all, the long-term care stay must be preceded by a three-day
hospitalization. Secondly, not all medical conditions
qualify for Medicare payment in the long-term care setting.
As a rule, the patient must be receiving professional
therapy services (physical, occupational or speech) five
days a week, or be receiving enteral nutrition (tube-feeding), or
be receiving education for a newly diagnosed condition (such
as a new diabetic being instructed on how to self-inject
insulin). In addition, there are certain situations that
would qualify for Medicare payment, such as the need for
skilled nursing assessment and/or observation as the result
of a recent health episode. If the above criteria are met,
Medicare will pay all expenses for the first 20 days of a
nursing facility stay. The remaining 80 days of the Medicare
benefit are subject to a co-insurance amount for which the
beneficiary is responsible. A supplemental insurance policy,
such as MediGap, will pick up the co-insurance amounts, as
well as the Medicare deductible.
Can
any services be paid for by Part B of Medicare?
Part B coverage under Medicare will pay for certain services
provided to a patient in a long-term care facility, even if
they are not a Part A inpatient. Urological supplies
(catheters, etc.), some wound dressings, and professional
therapy services are eligible for payment by Part B of
Medicare. The facility will let you know if any of the
services you are receiving are paid for by Part B.
Can
any services be paid for by Part D of Medicare?
Medicare Part D is a federal program that subsidizes the costs of prescriptions for Medicare beneficiaries. It is for all individuals enrolled in Medicare Part A and/or Part B or a Medicare Advantage plan. Enrollment in Part D is voluntary, and each plan varies in cost and formulary. Some individuals may qualify for prescription drugs at reduced or no cost. Medicare beneficiaries who were eligible but did not enroll during the enrollment period will have a late-enrollment penalty, although some individuals do have creditable coverage and are exempt from the penalty. For further information about Medicare Part D, you may contact SHIINE at 1-800-536-8197.
If
a person runs out of money, doesn't Medicaid pay for their
care in a nursing facility?
One of the largest portions of each state's Medicaid budget
is designated for payment of long-term care services for
qualifying beneficiaries. Applications for long-term care
assistance under the Medicaid program must be made through
the South Dakota Department of Social Services (DSS).
Eligibility is dependent upon asset and income guidelines.
The DSS calculates a formula for each eligible beneficiary
which shows what portion of their income (Social Security,
VA Pension, etc.) must be paid toward their nursing facility
care. From their total income, the beneficiary is allowed to
deduct the cost of a supplemental insurance premium, plus
they are allowed to retain $60 per month to meet personal
expenses.
What
if I don't need the level of care provided by a skilled
nursing facility? Are there other options?
There are more long-term care options available today than
ever before. Your physician will help make the decision
regarding which level of care is best for your particular
needs. For persons needing 24-hour monitoring and minimal
assistance, but not the skilled level provided by a nursing
facility, assisted
living might be the right option. Adult
day care is a service that has effectively met the
needs of many individuals who might require care and
services only during the daytime hours when their regular
caregiver is at work. For others, congregate
housing might provide the appropriate level of
assistance. This level of independent senior housing
provides nutritious meals and housekeeping assistance on a
regular basis. Still others might find that they can
function effectively in their own home with some assistance
from a home health
agency, which provides nursing and/or personal care
services right in an individual's home.
Should
I buy a long-term care insurance policy and, if so, how do I
know if it's a good policy?
Long-term care insurance is a rapidly growing option as a
means of paying for care in a long-term care facility. Three
key items to look for in a policy are how much does it pay
per day (and will that amount be adequate for the average
cost in your area); when does it begin paying (some policies
being paying after 90 or 100 days, assuming that Medicare
will pay for a portion of the stay); and what is the
duration of the policy (will it pay for long-term care for
one year, indefinitely, etc.). Because of the popularity of
the assisted living level of care, you might also want to
ask if the policy would cover care in an assisted living
facility. There are hundreds of long-term care policies out
there, so the best rule to follow in finding a good product
is to consult with an insurance agent that you trust.
Does Jenkins Living Center accept credit cards?
Yes, though only Visa, Mastercard and Discover are accepted at this time. For more info regarding payments, please contact the Business office.
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