Frequently Asked Questions

Frequently Asked Questions

Here you will find the answers to frequently asked questions from families and potential residents. If you have a question that we did not address, please contact us.

Medicaid Frequently Asked Questions

What is Medicaid and who does it cover?

What is Medicaid and who does it cover?
What is Medicaid and who does it cover?

Medicaid is a joint Federal and State program that helps pay medical costs for some people with limited incomes and resources. Most of your health care costs are covered if you have Medicare and Medicaid. Medicaid programs vary from state to state. People with Medicaid may get coverage for services such as nursing home and home health care, that aren’t fully covered by Medicare.

For more information about Medicaid, call your State medical assistance office or visit the Medicaid Section of www.cms.hhs.gov.

You may also be interested in the Medicare Savings Programs. States have programs for people with limited income and resources that pay Medicare premiums and, in some cases, may also pay Medicare deductibles and coinsurance. These programs help millions of people with Medicare save money each year. It's very important to call your State medical assistance office if you think you qualify for the Medicare Savings Programs, even if you aren't sure.

How can Medicaid help people with low incomes?

How can Medicaid help people with low incomes?
How can Medicaid help people with low incomes?

A: Medicaid is a joint Federal and State program that helps with medical costs for some people with low incomes and limited resources. To qualify for Medicaid, you must have a low income and few savings or other assets. Medicaid coverage differs from state to state. In all states, Medicaid pays for basic home health care and medical equipment. Medicaid may pay for homemaker, personal care, and other services that are not paid for by Medicare. Medicaid has programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who are entitled to Medicare and have a low income.

If you would like to speak with one of the financial professionals that The Ambassador has made available to you, please contact the following:

Accounts Receivable
Vanessa Barrett, 402-873-8528
Kris Ramage, 402-873-8505
Lauretta Harker, 402-873-8504
Kim Manion, 402-873-8508

Billing
Barb Jensen, 402-873-8529
Shelly Bergonia, 402-873-8526

Medicare Frequently Asked Questions

What is Medicare?

What is Medicare?
What is Medicare?

Medicare is health insurance for people 65 years or older, under age 65 with certain disabilities, and any age with end-stage renal disease (ESRD) or Lou Gehrig's disease. Medicare has four parts -- Part A, which is hospital insurance, Part B, which is medical insurance, Part C, which is Medicare Advantage Plans, and  Part D, which is Prescription Drug Coverage.

Who is eligible for Medicare?

Who is eligible for Medicare?
Who is eligible for Medicare?

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medical Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

You are receiving retirement benefits from Social Security or the Railroad Retirement Board. You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them. You or your spouse had Medicare-covered government employment.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig's disease, your Medicare benefits begin the first month you get disability benefits.) You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, call the Social Security Administration or visit their web site. The toll-free telephone number is: 1-800-772-1213. The TTY-TDD number for the hearing impaired is 1-800-325-0778.

What does Medicare pay for?

What does Medicare pay for?
What does Medicare pay for?

Medicare covers certain medical services and supplies in hospitals, doctors' offices, and other health care settings. Services are either covered under Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). If you have both Part A and Part B, these services and supplies must be covered as long as they are reasonable and necessary for your health, no matter what type of Medicare plan you have. A list of the covered services is found in the Medicare handbook.

What does Medicare Part A cover?

What does Medicare Part A cover?
What does Medicare Part A cover?

Medicare Part A helps pay for care in the following facilities if they are medically necessary based on Medicare requirements, and your eligibility for Medicare Part A.

Medicare Part A Covered Facilities

Inpatient care in hospitals (including critical access hospitals) Skilled nursing facilities (SNFs) Long Term Care Hospital (LTCH) Inpatient Rehabilitation Facility (IRF) Hospice care Home health care Beneficiary access to religious nonmedical health care institution (RNHCI) services Inpatient Mental health/psychiatric care Obesity Bariatric Surgery Medicare Part A helps pay for the following services if they are medically necessary based on Medicare requirements. You must be eligible for Medicare Part A in order to get the following services.

Medicare Part A Covered Services

Anesthesia Chemotherapy Room and Board All meals and special diets General nursing Medical social services Physical, occupational, and speech-language therapy Drugs with the exception of some self-administered drugs Blood transfusions Other diagnostic and therapeutic items and services Medical supplies and use of equipment Respite care in hospice Transportation services Inpatient alcohol or substance abuse treatment Part A blood (see the restrictions under noncovered services) Clinical Trials (Inpatient) Kidney Dialysis (Inpatient)

Does Medicare pay for nursing home stays?

Does Medicare pay for nursing home stays?
Does Medicare pay for nursing home stays?

Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, you must receive the services from a Medicare certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay is the amount of time spent in a hospital just prior to entering a nursing home. This is at least three days. To learn more about Medicare payment for skilled nursing home costs, contact your State Health Insurance Assistance Program (SHIP) in your State. 

What is the current Medicare coverage for LTC, nursing home care, and SNF care?

What is the current Medicare coverage for LTC, nursing home care, and SNF care?
What is the current Medicare coverage for LTC, nursing home care, and SNF care?

Generally, Medicare does not pay for long-term care. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities. Most long-term care is considered to be "custodial care."

Custodial care is nonskilled, personal care, such as help with activities of daily living like bathing, dressing, eating, getting in or out of bed or chair, moving around, and using the bathroom. It may also include care that most people do for themselves. Medicare does not pay for custodial care.

Medicare pays only for medically necessary skilled nursing facility (SNF) care. Generally, skilled care is available only for a short time after a hospitalization. Skilled care is health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. Examples of skilled care are changing sterile dressings and physical therapy.

Our publications titled Medicare Coverage of Skilled Nursing Facility Care and Guide to Choosing a Nursing Home provide additional information about long-term care, nursing home care, and skilled nursing facility care that may be helpful to you.

Whether you are seeking skilled care following a hospitalization (covered under Medicare) or long-term custodial care (not covered by Medicare), the Centers for Medicare & Medicaid Services (CMS) is committed to providing the information you need to choose a nursing home for a family member or yourself.

Should I sign up for Medicare Part B?

Should I sign up for Medicare Part B?
Should I sign up for Medicare Part B?

Most people sign up for and buy Medicare Part B. If you want to join a Medicare managed care plan or a Medicare Private Fee-for-Service plan, you will need to have both Medicare Parts A and B. If you are still working, read our FAQ, call the Social Security Administration at 1-800-772-1213 or visit their web site for more information or to enroll.

I have more than one insurance. How do I know who pays first?

I have more than one insurance. How do I know who pays first?
I have more than one insurance. How do I know who pays first?

If any of the following situations apply to you, your other insurance may be primary to Medicare, meaning the other insurance pays first: You have Medicare; are still working; and are covered by your employer’s health insurance plan;You have Medicare, are retired, but your spouse is working and has a health plan that also covers you; orYou are injured on the job, in an automobile accident, or slip and fall at a shopping center (worker’s compensation, auto insurance or liability insurance may cover the cost of medical care related to the accident).

You can contact the Coordination of Benefits Contractor at 1-800-999-1118 for questions about, or to report changes in, your primary insurance. Medicare has a dedicated “Coordination of Benefits Contractor” that keeps track of when Medicare is primary or when another insurer is primary. If you have other insurance and it pays after Medicare, it is called your supplemental insurance. Supplemental insurance often covers the deductible and/or co-payments required by Medicare. Examples include: Retiree insurance from your former employer or union;Medigap insurance;Tricare for Life (for military retirees); and Medicaid.

If you change your supplemental insurance, or are experiencing problems with supplemental insurance payments, you need to call your old and new supplemental insurance companies. If you have questions about how your supplemental insurance works with Medicare, contact the supplemental insurer. If you need Medicare to start or stop sending claims information to a supplemental insurance company, again, this is something the supplemental insurer must resolve. The Medicare publication, Medicare and Other Health Benefits: Your Guide to Who Pays First contains additional information on this topic that you may find useful.

General Questions and Concerns

What should you look for in selecting a rehabilitation program?

What should you look for in selecting a rehabilitation program?
What should you look for in selecting a rehabilitation program?

What should you look for in selecting a rehabilitation program?

Selecting the appropriate rehabilitation facility and program can be an overwhelming decision. First and foremost, you should contact the rehabilitation facilities that you’re considering. When you call, ask to speak with the Admissions Coordinator and schedule a tour. During your first interaction with the facility, you’ll want to pay attention to the friendliness and helpfulness of the staff assisting you.

While touring the rehabilitation facility, you’ll want to inquire into the following:

Does the facility specialize in short-term rehabilitation?
When a facility specializes in short-term rehabilitation, every aspect of its program from the specially-trained staff to the therapy equipment available, will be geared towards meeting the needs of rehab patients.

Does the facility possess a strong rehabilitation team?
An interdisciplinary team of rehabilitation professionals will include occupational therapists, physical therapists, speech therapists, and respiratory therapists.

Does the facility offer adequate therapy equipment and/or space?
While large therapy gyms are conducive to large numbers of patients receiving treatment at the same time, some of the most productive therapy sessions will take place throughout the rehabilitation facility. This allows the patient to be mobile during therapy treatments and utilize a larger space to enhance stamina, endurance, and strength.

Does the rehabilitation program work to get patients back to their own home?
A respectable rehabilitation program will confidently tout their patient success rate; it might also include the average length of stay for its short-term rehab patients.

Is the staff friendly and respectful of the patients?
A rehabilitation program should center around positivity and the desire to enhance its patients’ lives. The staff is the most important aspect of a rehabilitative program, and as a potential patient or family member, pay close attention to your interactions with the staff at the facility.

What is the difference between physical, occupational, and speech therapy?

What is the difference between physical, occupational, and speech therapy?
What is the difference between physical, occupational, and speech therapy?

Physical therapy is defined as:

The treatment of pain, disease, or injury by physical means; the profession concerned with promotion of health, with prevention of physical disabilities, with evaluation and rehabilitation of persons disabled by pain, disease, or injury, and with treatment by physical therapeutic measures as opposed to medical, surgical, or radiologic measures.

Physical Therapists at The Ambassador focus on:

  • Enhancing balance skills to help prevent falls
  • Improvement of walking and general mobility • Increased strength and range of motion • Improvement of joint mobility, muscle strength, and coordination  

Occupational therapy is defined as:

Therapy based on engagement in meaningful activities of daily life (as self-care skills, education, work, or social interaction) especially to enable or encourage participation in such activities despite impairments or limitations in physical or mental functioning.

Occupational Therapists at The Ambassador focus on:

  • Increased independence in daily living skills
  • Education of patients on muscle re-education, energy conservation, and compensatory techniques
  • Building up the patient’s self-worth and confidence to perform daily tasks independently
  • Providing home assessments to ensure a safe transition home for patients

Speech therapy is defined as:

The treatment of speech and communication disorders. The approach used depends on the disorder. It may include physical exercises to strengthen the muscles used in speech (oral-motor work), speech drills to improve clarity, or sound production practice to improve articulation.

Speech Therapists at The Ambassador focus on:

  • Achieving maximum communication skills in speaking, self-expression, and understanding
  • Increasing swallowing ability through skilled evaluation and treatment
  • Development of functional independence through decision making, reasoning, and memory

What items should I bring for my transitional rehabilitation stay?

What items should I bring for my transitional rehabilitation stay?
What items should I bring for my transitional rehabilitation stay?

For your transitional rehabilitation stay, you should plan on bringing seven changes of clothing that will be conducive to the rehabilitative setting. This includes comfortable pants, shirts, socks and shoes that will provide traction and remain secure on your feet during therapy sessions. You will also want to bring a week’s worth of undergarments and a sweater or jacket.

Although your stay will be short-term, you may also want to bring a few items that bring you comfort. For example, a picture of your family, a book, or a laptop computer/tablet.