Questions and Answers

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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 ADMINISTRATOR.

Will Medicare pay for my stay in a nursing facility?
The long-term care benefit under Part A of the Medicare program consists of potentially 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. As long as a resident is receiving a daily skilled service as determined under the Medicare regulations, Medicare will pay for room & board as well as most prescription medications 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. If a resident has a supplemental insurance policy, such as MediGap, or state Medicaid, the co-insurance amounts, as well as the Medicare deductible, may be covered. Please note that all Medicare stays are subject to the requirements established by Medicare. The facility social services department or Medicare nurse can help determine eligibility. Most rehab stays under Medicare do not receive the full benefit limit. Daily needs determine eligibility.

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.

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 things 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. Chances are, they're not going to steer you wrong.