Medicare

Before your loved one moves into his or her new home, it is important to know what the benefits will cover. Gold Medallion understands that you have many questions. The following should address those issues.

How do I become eligible for Medicare Part A in a skilled nursing facility?

The Gold Medallion Director of Nursing and Medicare Coordinator will evaluate your loved one in her home or while she is hospitalized. The Medicare qualification is based upon this evaluation. Once she has been evaluated, our Nurse will recommend to proceed with the Medicare benefits.

• You must have a Medicare card that reads hospital insurance.
• Your physician must certify that you need skilled care on a continuing basis.
• You must spend a minimum of three consecutive days (not counting day of discharge) in a hospital no longer than 30 days prior to entering the skilled nursing facility.

What are the Medicare rates if the qualifying criteria are met?

• 1-20 DAYS Resident pays nothing; Medicare pays in full.
• 21-100 DAYS There will be a $141.50 daily co-payment to be paid by insurance or private funds.
• 100+ DAYS Medicare no longer pays.

Does Medicare pay me directly?

No. Medicare pays the provider of the medical services (skilled nursing facility). The provider will send the bill to Medicare. Medicare Part B If you have medical coverage under Medicare Part B and are eligible for the services provided, you will be responsible for 20 percent of the total charges of the following services:

• Occupational therapy
• Physical therapy
• Speech therapy
• Medical supplies.