Payment Options for Your Stay

When faced with the need for medical care, many people are confused about how their care will be paid. There are several payment programs and options for payment of medical care. We participate with Medicare, Medicaid and many private insurance providers. Our business staff is well versed in the financial aspects of paying for nursing facility stays. Please feel free to contact our staff to discuss your specific needs.

Medicaid is a federally regulated insurance program, but Pennsylvania establishes its own requirements and eligibility criteria. The Medicaid program is designed to provide medical benefits to those that have low income, no insurance or are under insured. If you would like more information about Medicaid, please visit http://www.cms.gov or http://www.dhs.pa.gov for eligibility or ask our Business Office staff to assist you.

Medicare is a health insurance program for people 65 or older and people under 65 with certain disabilities. Medicare does not cover all expenses and is not designed to pay for long-term custodial care. Medicare has several programs that offer different types of coverage

Medicare Part A helps pay for hospital stays, skilled nursing and rehabilitative care, home health and hospice care. Medicare helps pay for some of the costs of a skilled nursing and rehabilitative stay such as a semi-private room, meals, skilled nursing care, rehabilitation services and some medical supplies for a skilled nursing stay after a related three-day inpatient hospital stay. Medicare will pay 100% of days 1-20 of a qualified skilled nursing stay, if days were not used elsewhere, but there is a coinsurance charge for days 21-100.

Medicare Part B helps pay for doctors’ services and outpatient care as well as some other services such as therapy and some home healthcare services and supplies when medically necessary.

Medicare Part C is a managed care benefit that a Medicare beneficiary may enroll in. This is called a Medicare Advantage plan and may have different rules than the traditional Medicare plan.

Medicare Part D is a prescription Drug coverage that Medicare beneficiaries may choose to enroll in. The costs and coverage varies by plan and income levels.

Medicare’s premium, coinsurance and deductible amounts change each year. Our Business Office staff can give you current rates and information or you may visit http://www.medicare.gov or call 1-800-Medicare for more information.

COMMUNITY HEALTHCHOICES (CHC) is Pennsylvania’s mandatory managed care program for dually eligible individuals and individuals with physical disabilities.

IF YOU ARE ELIGIBLE FOR COMMUNITY HEALTHCHOICES (CHC), THE WAY YOU RECEIVE YOUR MEDICAL ASSISTANCE (ALSO CALLED MEDICAID)

If you receive Medical Assistance and have Medicare, are in a nursing facility, or receive services at home through an Office of Long-Term Living (OLTL) waiver, you may move to CHC.

You will need to choose a CHC health plan for your Medical Assistance services. CHC WILL NOT CHANGE YOUR MEDICARE BENEFITS.