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.
Medicare Frequently Asked Questions
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.
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.
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.
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)
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.
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.
Generally speaking, 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.
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; or You 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.