HH_GuideForFamilies_2012 - page 34

Charles E. Smith Life Communities
Will Medicare pay for my stay at the Hebrew Home?
Residents who enter the Hebrew Home
following a hospital stay may qualify for
this coverage for a limited time, if all the
criteria listed below are met. Medicare is
a Federal insurance program, and it is
designed to cover hospitalizations and
rehabilitative services, not the on-going
daily cost of long-term care.
What Medicare covers in long-term care
Even though you are in a senior health care
Medicare Part B
will continue
to pay for physician visits, therapy, hospital
stays, and lab and x-rays at 80 percent, and
Medicare Part D
can help with prescription
drug costs.
Because you are moving to a senior
health care community, you will have the
opportunity to sign up for
Medicare Part D
coverage or change your Medicare Part D
prescription drug benefit plan to one that
is accepted by the Home’s pharmacy.
The pharmacy accepts several plans,
including plans offered at no premium
to individuals who are eligible for both
Medicare A and Medicaid. Contact your
social worker or the pharmacist at
for further information.
Factors that determine if Medicare Part A
will pay for your care
All five of these conditions must be met:
1. You have Medicare Part A (Hospital
Insurance) and days left in your
benefit period.
2. You have a qualifying hospital stay:
a. Spending 3 or more consecutive days
in the hospital, not counting the day
you leave.
b. Entering the Hebrew Home within
30 days of leaving the hospital.
c. Requiring skilled nursing or rehabilitation
services related to your hospital stay.
After you leave a skilled nursing facility
(SNF), you will not need another 3-day
qualifying hospital stay if your reenter the
Home or a different SNF within 30 days.
This is also true if you stop getting skilled
care and then start getting skilled care again
within 30 days.
3. Your doctor has decided that you need
daily skilled care. This care must be
given by, or under the direct supervision
of skilled nursing or rehabilitation staff.
If you are in the Hebrew Home for skilled
rehabilitation services only, your care is
considered daily care even if these therapy
services are provided 5 or 6 days/week.
4. You get these skilled services in a
facility certified by Medicare (such as
the Hebrew Home).
5. You need these skilled services for a
medical condition that:
a. Was treated during a qualifying 3-day
hospital stay, or
b. Started while you were getting Medicare-
covered skilled care. For example, you
came to the Hebrew Home because you
had a stroke, and you developed an
infection that required IV antibiotics.
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