 | Larry Nanny is the Administrator at Lakewood Senior Living located off of Kellogg Drive on Seville St, between Tyler and Maize Rd. He has a degree in Health Administration, and has been a Nursing Home Administrator for three years. Larry is passionate about helping people. Prior to becoming an Administrator he was a teacher at Wichita Area Technical College where he taught Horticulture. Larry also has served in the Air National Guard and was stationed near Iraq during Desert Storm were he trained arriving troops in chemical weapons warfare. In his spare time Larry likes to spend time with his family, which includes his lovely wife, and their three dogs. Larry is a certified Personal Trainer and an avid fitness enthusiast. He enjoys playing and watching sports, including football, baseball and basketball. Feel free to contact Lakewood Senior Living for assistance if you need more information on our fall prevention program or long-term care, please call (316) 722-6916. |
Senior Living
2007-05-01 16:21:00
Medicare benefits are available
Medicare is a federal health insurance program for people aged sixty-five and over, people of any age with permanent kidney failure, and certain disabled people under age 65. This program is administered by the Centers for Medicare and Medicaid. Almost everyone qualifies for Medicare upon reaching age 65 either through their own employment or through a spouse.
There are two distinct benefits under Medicare guidelines, Part A and Part B. Part A is considered an entitlement program and does not require premiums to be paid. You automatically receive Part A after meeting certain requirements. Part B is an optional program, where participants have to elect a plan and pay premiums to receive benefits.
Medicare as a payer source in a Skilled Nursing Facililty is designed as a short term benefit. To qualify for your Medicare benefit in a Skilled Nursing Facility you must meet certain requirements. First, you must need at least one of these “skilled” services, 1) Nursing Evaluation and Management, 2) Nursing Observation and Assessment, 3) Nursing and/or Rehabilitative Teaching or Training, 4) Direct Skilled Nursing Services, and 5) Physical, Occupational or Speech Therapy.
Secondly, you must have had a consecutive three day stay in a hospital, not including day of discharge. Thirdly, there has been less than thirty days that have elapsed since a three day hospital stay. This would be a circumstance that a person went home from the hospital and then realized they could not make it at home yet. As long as you are admitted into a skilled facility prior to thirty days elapsing since your qualifying stay at the hospital you can use your Medicare benefit. Lastly, the physician has to certify that the patient needs skilled care.
A patient that meets Medicare criteria for a stay in a skilled nursing facility is entitled to up to 100 days. The patient is not guaranteed these 100 days, that is the maximum benefit.
The patient still has to meet the qualifying criteria of needing a skilled nursing service or skilled rehabilitative services. As soon as a patient reaches their prior level of functioning or has gone for a period of time with no improvements or progress being achieved they can no longer use their Medicare benefit. The facility is required to give the family or patient a three day notice that the Medicare benefit is coming to an end.
Medicare will pay for the first twenty days covered at 100%. Days 21-100 requires a co-pay. This is where the Part B optional program comes into play. If a patient has Medicare Part B, their co-insurance will be covered. Therefore their stay will still be covered at 100% as long as they still need skilled services. If the patient does not have Part B, they are required to pay the co-insurance, which is $124.00 per day.
Patients can qualify for a new benefit period after sixty days have elapsed since their previous hospital or skilled nursing. This is considered a “break of illness.” The patient will still need to meet other requirements mentioned previously.
Medicare, as a benefit in a skilled nursing facility is a great benefit, but there a very strict guidelines that must be met by the patient, physician and the facility.
