An explanation of payment programs available at Transitions Nursing and Rehabilitation Center is outlined in our Financial Care Guide* and will be provided upon admission. It outlines the resident’s financial responsibility and assists in identifying sources which might help pay for costs of care. A brief explanation of pay sources is included here for your review. By working closely with resident and family, our staff is committed to help each resident get the most of any financial benefits available to them. Please don’t hesitate to ask questions or provide additional information that will help us serve you better.
Some residents pay privately for costs of care, while others are eligible for financial assistance. Our Admissions Counselor and Business Office Manager will work with residents and their families to identify appropriate third-party payers that may be available to help off-set the cost of care for the resident.
Third-party pay sources are available based on eligibility standards, and may be temporary or permanent. Third party payers may include Medicare or Medicaid.
We strive to work with the resident and/or their family to ensure all payments for care and services, regardless of source, will be obtained in a timely manner. This may require cooperation of the family to complete appropriate forms, attend follow-up meetings and make follow-up calls to help secure payment. When benefits from third-party payers are exhausted, charges for resident care become a private pay responsibility.
*The Guide is for clarification only and does not represent a contract with the facility. A separate Admissions Agreement must be signed by Resident and/or Resident’s Responsible party, outlining specific financial obligations enforceable under Illinois law.
A minimum 30-day deposit is required for all residents who will be admitted as private pay. An additional, pro-rated amount will be computed for admissions occurring after the 15th of the month. Payment is expected when admission paperwork is completed. A monthly statement will be sent on the 25th of the month, and all charges are due by the 10th of the following month.
No down payment is required. Skilled nursing benefits are available under Medicare Part A. This is a limited benefit and is not a long-term payment option. To qualify, Medicare recipients must have had three consecutive midnights in the hospital as an in-patient (overnight in the emergency room does not count toward this requirement). Once eligibility is determined, the patient has up to 100 days available in a skilled nursing facility, and must medically qualify for each day of their stay. Individual circumstances will determine whether or not a patient will qualify for a full 100-day benefit period. Our professional care giving team meets weekly to discuss each Medicare patient’s progress to ensure all available Medicare benefits are utilized. We require a copy of resident’s current Medicare card for our financial file.
A detailed explanation of Medicare Part A is included in our Financial Care Guide, the annual “Medicare And You” bulletin (sent to Medicare recipients every October) or on-line. However, basic guidelines under Medicare Part A for qualified patients are as follows:
- Day 1 - 20 = 100% coverage (no cost to patient)
- Day 21- 100 = Medicare pays all but a daily co-payment amount. This amount is set by the federal government, and varies from year to year. All nursing facilities must charge the same co-payment amount, regardless of services provided.
- Medicare co-payments are the financial responsibility of the resident and/or resident’s responsible party. If there is no alternative pay source for these co-payments, such as a Medicare supplement or Medi-gap policy, this becomes a private pay responsibility, as defined above.
MEDICARE D PRESCRIPTION COVERAGE
The Medicare D Prescription Drug program which went into effect on January 1, 2006 continues to evolve. These benefits extend into the nursing home setting for both private pay, and Medicare/Medicaid eligible residents. Our staff will be pleased to explain how the Medicare D program can benefit you or your loved one upon admission to the nursing facility.
Determination is based on physical need (by a state mandated pre-screening) and financial circumstances. If a resident has a current Medicaid benefit number, the facility will work with the resident’s case worker to determine the specific amount owed by resident, if any. In some cases, Medicaid will pay all costs of care. Allowances are made for married couples, and it is worth the time to understand the Medicaid guidelines for couples. The allowances are quite generous and allow for a reservation of assets for the spouse who will continue to reside at home. The specific details of the program for the current year are outlined in our Financial Care Guide or on-line. We require a copy of the current Medicaid card for our files.
If resident has no current Medicaid benefit at the time of admission, an application must be submitted. It is the resident/family’s responsibility to provide accurate information to complete the application process in a timely manner. Resident, or resident’s family, are asked to cooperate with Medicaid caseworkers to ensure appointments are kept and paperwork is completed accurately. Eligibility for Medicaid is determined by the Illinois Department of Health & Family Services, not the facility. In many cases, a down payment to cover resident’s shared portion may be required. The facility will make a determination, based upon resident’s income, of an amount to be paid to the facility on a monthly basis, pending verification of approval by Illinois Department Human & Family Services. Resident’s account will be adjusted accordingly upon final determination by the Department. It should be noted that until a resident actually applies for Medicaid, the resident is classified as Private Pay, at Private Pay rates, subject to Private Pay terms above.
While the determination is being made by the Department, it is in the resident’s and family’s best interest to refrain from spending any income earned by the resident. Waiting until a determination is made will ensure resident’s portion for costs of care is reserved, preventing unnecessary out-of-pocket expense for the resident’s family.
Medi-Gap or Supplement
We will perform a verification of benefits to determine if Medicare co-payment days will be covered. We will also verify whether or not any extended benefits are available beyond the Medicare benefit period, and negotiate terms in this regard. In order to do this, we require a copy of the current insurance card with telephone verification numbers and policy information.
Managed Care or Fee For Service
We will perform a verification of benefits and negotiation of rates. In order to do this, we require a copy of the current insurance card with telephone verification numbers and policy information.
Many times veterans are entitled to Medicare benefits, while some veterans qualify for special programming through the Veteran’s Administration. We will be happy to work with the resident to determine if a VA benefit program is available.
In order to serve you better and provide you with accurate information regarding pay source options available to you, we ask that you bring the following information with you to your Admission Paperwork appointment for verification:
- Medicare Card
- Medicaid Card, if applicable
- Medicaid Pending - Proof of appointment and/or application made from Medicaid
- Insurance Cards (Medical, HMO, and Prescription Drug Plans)
- Circuit Breaker information
- Checkbook (to pay any private funds that may be due)
Other non-financial forms, if applicable to your situation, should also be brought in at time of Admission Paperwork appointment:
- Durable Power of Attorney or Power of Attorney for HealthCare forms
- Copies of any other applicable Advanced Directives, such as Living Will
- Medical ID cards for pacemakers, implants, etc. which we should keep on file in case of emergency.
In an effort to serve you better, we offer a basic financial screening to assist residents who wish to apply for Medicaid through the Department of Human and Family Services.
This screening is voluntary, however, individuals seeking Medicaid who decline to provide this information at the time of admission will be expected to pay privately until the application for assistance is approved.
It is suggested that the Medicaid application process be initiated six months prior to exhaustion of funds. Allowances are made for married couples, and it is worth the time to become familiar with the Medicaid guidelines for couples. The allowances are quite generous and allow for a reservation of assets for the spouse who will continue to reside at home. More information is available in our Financial Care Guide or you may get more information on-line.
Our social services department will be pleased to assist with the Medicaid application process and will work with resident and family to ensure timely completion of all forms.
Basic Financial Screening**
Income from Social Security __________________________
Income from Pension ________________________________
Income from Investments _____________________________
Income from Rental Properties _________________________
Other Income _______________________________________
Total Income: _______________ Less $30 _____________
Estimated Amount Due for Resident’s Shared Portion** (Applied Income): __________
** Medicaid residents only.
Paying for costs of care can be a delicate and detailed process. Our staff is committed to working with residents and their families to find ways to ease the financial burden. Cooperation from residents and their families is very much appreciated.