Coverage FAQ's

We put together a list of common questions our admissions consultants get asked often. We hope this will help answer a few of the questions you may have about coverage options. If you still have questions, our admissions consultants are here for you. To schedule
a FREE consultation, click here.
What are the differences between Medicare parts A, B, C, and D?
There are four parts to Medicare:
  • Medicare Part A - Hospital Insurance
  • Medicare Part B - Medical Insurance
  • Medicare Part C - "Medicare Advantage" which was formerly know as Medicare + Choice
  • Medicare Part D - Prescription Drug Coverage
Generally, people who are over age 65 and getting Social Security automatically qualify for Medicare Parts A and B. So do people who have been getting disability benefits for two years, people who have amyotrophic lateral sclerosis (Lou Gehrig's disease) and receive disability benefits, and people who have permanent kidney failure and receive maintenance dialysis or a kidney transplant.

Part A is paid for by a portion of Social Security tax. It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services.

Part B is paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury. It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A.

Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization (HMO). These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee. You must have both Parts A and B to enroll in Part C.

Part D (prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare. Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.
What is the difference between Medicare and Medicaid?
Medicare

Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of the cost through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services (CMS), an agency of the federal government.

Medicaid

Medicaid is an assistance program. Medical bills are paid from federal, state and local tax funds. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines.
If I am on Medicare, how much therapy will I receive?
Medicare gives levels and based on your prior functioning level, diagnosis, current level and prognosis determines how much you will receive. These are National Medicare guidelines.
If I pay privately then get approved for Medicaid, does my room or type of care I receive change?
In this facility the type of care does not change. The aides are not aware of each individual's payer source. Since all of our rooms on our long term unit are certified for Medicaid, the resident's room does not change.
Will I have therapy everyday?
Our Therapy department is operational 6 days a week, Monday through Saturday. Five days a week you will have the same Therapist, unless he/she takes a day off. The 6th day you would have a different Therapist.