This page is designed to answer frequently asked questions about Medicare and Medicaid. In this section, you will see underlined text that represents external links to sites on the Worldwide Web with more information. By clicking on this text, you will go to a different place on the Web, simply use the Back button in your browser to return here or type https://beverlynet.com in the address field in your browser.

Following is a list of topics covered in each section, select a topic to read about it, or scroll down the page to read the document in its entirety.

Medicare	Medicaid
What is Medicare?	What is Medicaid?
What are the Qualifications for Medicare?	What are the Qualifications for Medicaid?
What is Covered by Medicare?	When and How do I Apply for Medicaid?
What do I Pay For under Medicare?	What Part Will I Pay For?

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MEDICARE

What is Medicare?

Medicare is a federal health insurance program for people who are 65 years old or older, have been disable for at least two years, or have End-Stage Renal Disease (ESRD). Medicare provides health service benefits in two parts: hospital insurance, called Part A, and medical insurance, called Part B.

Medicare is an extensive program and the information included below has been tailored by Beverly Enterprises to cover transitional nursing care facilities.

What are the Qualifications for Medicare?

To qualify for Medicare, you must:

• Complete a hospital stay of at least three days (not including the day of discharge).
• Be admitted to a health care center within 30 days of discharge from the hospital, or within 30 days of a previous Medicare-covered nursing care stay.
• Have your doctor certify that following your hospital stay, you require a daily skilled service provided in a certified Medicare bed by a licensed nurse or therapist.

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  What is Covered by Medicare?

  Medicare covered health care center services and supplies include:

• Room and Board
• Physical Therapy
• Occupational Therapy
• Respiratory Therapy
• Speech/Language Pathology
• Complex Medical Equipment
• X-Ray / EKG
• Pharmacy
• Oxygen
• IV's
• Lab Services
• Medical Supplies

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  What You Pay For

  This information is specific to post-acute care, specifically nursing homes.

  You must first pay an annual Part B deductible of $100 before your Medicare benefits take effect.

  There are different levels of what's paid for based on the length of your stay.

  Day One to Day 20

  From day one to day 20 of your rehab stay, Medicare covers 100 percent of covered services and supplies. You pay only for non-covered services you receive, such as private room, private telephone and personal convenience items.

  Day 21 to Day 100

  From day 21 to day 100 you pay a daily co-insurance amount - for the covered services you receive and continue to pay the full amount for any non-covered services. This daily co-insurance amount is established annually by Medicare. During the remaining period, Medicare continues to pay the cost of your covered services over and above your daily co-insurance payment.

  Beyond Day 100

  If your health care center "stop-over" goes beyond 100 days, Medicare payments end and you become fully responsible for all nursing care changes incurred during the remainder of your stay. If you have supplemental health insurance, it may continue to reimburse covered expenses.
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  MEDICAID

  What is Medicaid?

  Also known as Title 19 of the Social Security Act, Medicaid is a state-administered program which helps pay for health care services required by individuals with limited financial resources.

  Medicaid is the largest program providing medical and health-related services to America's poorest people. Within broad national guidelines which the Federal government provides, each of the states:

• establishes its own eligibility standards;
• determines the type, amount, duration, and scope of services;
• sets the rate of payment for services; and
• administers its own program.
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  What are the Qualifications for Medicaid?

  Eligibility requirements vary from state to state. Generally, you must meet the following qualifications:

• You must be able to prove a financial need based on income and preset assets.
• You must not have sold, transferred or given away any assets or property outside the time perious established by your state.
• Your physician and.or state agency has certified a medical need.
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  When and how do I Apply for Medicaid?

  When you know that your resources will be exhausted and or you anticipate admission to a medical facility, you should plan to begin the application process. Keep in mind this is a lengthy process that can take 90 days or more and you should plan well in advance. Beverly facilities can manage this process for clients. If you are not a Beverly client, click here to search for the address and phone number for your state agency.
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  What Part Will I Pay for if I Qualify?

  Your financial responsibility will be determined by your ability to pay. In most cases, the resident is billed a flat monthly rate based on present available income. This charge is frequently referred to as "share of cost," "resident liability," "applied income," or "private portion." You may also be billed for non-covered items. Typical examples include over-the-counter drugs, barber or beauty services and personal convenience articles, depending on the state. Click here for a list of Medicaid Services.
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