NHC Bluffton - Medicare

Medicare

What is Medicare?

Part A

While in a skilled nursing facility, Medicare Part A (Hospital Insurance) will pay for up to 100 days of skilled care, provided that the resident requires a daily skilled service as defined by Medicare guidelines and the admission to the facility is within 30 days of a three day or more hospital stay. For the first 20 days, Medicare pays 100% of the covered charges and for the next 80 days, Medicare pays all but $128.00 per day of covered charges, provided the resident continues to require skilled care.
Medicare Part A pays for the following services except when another payment source is primary:

Semi-private room and board (excluding internal feeding)
Specialized rehabilitation services: Physical, Occupational, and Speech Therapies
Medications ordered by physicians
Ancillary central supply items including certain special equipment such as air fluidized beds
Oxygen, IV Fluids, Braces
Personal laundry services

The following chargeable services are not covered by Part A if they should be requested by the patient:

Beauty and Barber shop services
Telephone or Television
Services provided at a physician office, Physician ordered consultations
Private duty nurses or sitters
Payment to hold bed when patient is hospitalized
Services determined not to meet Medicare coverage criteria, and the patient has been notified in writing by the center

Part B

If the resident is not eligible for Part A benefits, the resident may receive services under Medicare Part B (Medical Insurance). Part B will pay for an unlimited time frame after the resident meets an annual deductible of $131.00. Part B pays 80% of allowable charges. Services covered include:

Physician fees
Specialized rehabilitation services when Part A is unavailable
Physician ordered consultations
Prosthetic items such as urological and internal feeding supplies

Part D

Medicare Part D helps pay for prescription drugs not covered by Medicare Hospital Insurance Part A.