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Medicare
is a federal health insurance program established to help
Americans 65 years or older, and those considered as disabled,
pay for health care. The program is designed to assist individuals
in paying health care bills associated with short term
challenges of a sudden and acute nature. From its inception,
the law has authorized Medicare payment for qualified Christian
Science nursing services provided in certified
Christian Science nursing facilities. Recent legislation
has classified Christian Science nursing facilities as Religious
Nonmedical Health Care Institutions (RNHCI). See list
of Christian Science nursing homes which are certified
by Medicare as Religious Nonmedical Health Care Institutions.
As
with most insurance programs, Medicare does not pay the entire
bill for covered care. It has deductibles and coinsurance
requirements that require you to pay part of the costs. There
are two major parts to Medicare called Part A and Part B.
Medicare
Part A and Part B Back
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Part A is called "Hospital Insurance" and helps
pay for room, board, covered nursing care and nursing supplies
in either a hospital or accredited nursing facility
(see below).
Because Broadview and Sunland are classified as RNHCIs,
they are considered "hospitals" for the purposes of
Medicare Part A coverage.
Part B is called "Medical Insurance" and can
only be used on the recommendation of a physician. This would
cover various medical procedures and equipment (see
below). It would never be used at Broadview or Sunland
because they have no medical physicians.
There is no charge for Part A coverage. It is a part of Social
Security benefits. There is a monthly premium charged for Part
B coverage ($96.40 in 2009) which is automatically deducted
from Social Security checks unless specifically declined in
writing 60 days after one becomes eligible to receive Social
Security benefits. At the time of your Social Security interview
to sign up for retirement benefits and/or Medicare, you can
verbally decline either part of Medicare.
Applying for Medicare
If you are nearing age 65, are not already receiving Social
Security or Railroad Retirement benefits and want to qualify
for Medicare benefits, you must apply for Medicare Part A and
you may wish to consider enrolling in Part B. You should call
the Social Security Administration at 800-772-1213, or visit
your local Social Security office 3 to 6 months before your
65th birthday.
Enrolling in Part A is included as part of your Social Security
benefits at no additional cost to you. Although enrolling in
Part B for an additional cost (see
above) is optional, you are automatically enrolled
in Part B unless you specifically decline it. You can enroll
in Part B for up to three months after eligibility. However,
if you wait until the month you turn 65 or later to enroll,
enrollment will not take effect immediately, and the delays
increase the longer you wait. If you miss this first enrollment
period, you have to wait until the next January to enroll, and
coverage will not begin until the following July.
A few things to consider about accepting
or declining Part B coverage: Back
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1. Part A is called "Hospital Insurance" and
helps pay for room, board, nursing care, and supplies in either
a hospital or Christian Science nursing facility. Part A is
used at Broadview and Sunland. Part B is called "Medical
Insurance" and can only be used on the recommendation of
a physician. This covers various medical procedures and equipment
such as the setting of bones, ambulance to a medical hospital,
rental or purchase of a wheelchair, walker, etc., with the approval
of a physician.
2. If you plan to purchase a Medigap or Medicare Supplement
Insurance Plan (see insurance),
these would usually require Part B coverage.
3. If at any time in the future you decided to enroll
in Part B coverage, there is a permanent 10% surcharge added
onto the premium for every 12 months that you could have been,
but were not, enrolled in this program.
Eligibility for Medicare Reimbursement
for Christian Science Nursing Care Back
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Christian Science nursing care must meet very specific criteria
to qualify for Medicare reimbursement. For Medicare purposes,
the nursing care must require the judgment, skill, oversight,
observation, or direct care of a Journal-listed Christian Science
nurse. Generally, the nursing need must include at least one
of the following:
- full care in bed o the full assistance of one or more nurses
to walk
- the dressing and bandaging of a wound o assistance to ensure
proper and adequate nourishment.
It is not unusual for Medicare coverage to vary during the course
of a benefit period since the nursing needs of a patient may
change. An assessment is made daily to determine if the needed
care continues to qualify for Medicare coverage. For that reason,
Medicare coverage does not necessarily start when Christian
Science nursing care begins nor does it always remain in place
for the duration of a patient's stay in a facility.
Again, to be eligible to receive Medicare benefits, a person
must be 65 years of age and sign up for Medicare at a Social
Security office. Individuals who are not yet 65 may also qualify
because of certain claims of disability. A Medicare card will
be issued when eligibility is established.
Note: Normally, a medical diagnosis is needed to confirm eligibility.
However, there is a special provision in the Medicare law that
allows an individual to utilize his or her Medicare benefits
at a Religious Nonmedical Health Care Institution without a
medical diagnosis. Medicare recognizes both Broadview and Sunland
as Religious Nonmedical Health Care Institutions. Both are periodically
inspected and re-certified for this purpose under Medicare.
Conditions Not Eligible for Medicare
Reimbursement
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There are circumstances that warrant nursing assistance but
which, in and of themselves, are not eligible for Medicare reimbursement.
These include, but are not limited to, inability to stay at
home alone, anxiety or depression, incontinence, and mental
confusion. Christian Science nurses may lovingly and skillfully
care for these needs, but the cost is not reimbursable by Medicare.
Each patient or family member should inquire about financial
assistance available at a nursing facility as well as refer
Financial Assistance.
Medicare
Coverage for Christian Science Nursing Care
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For patients whose nursing need qualifies for Medicare reimbursement
(see eligibility),
the following lists indicate what Medicare will reimburse and
will riot reimburse.
Medicare Part A pays for:
- necessary nursing services (excluding religious-based nursing
services such as reading to patients and metaphysical support)
- a room and meals
- most nursing supplies
Medicare
Part A does not pay for:
- Care that does not require the skill of a Journal-listed
nurse
- Christian Science practitioner fees
- Rental or purchase of health care equipment
- Personal convenience extras such as telephone, hairdresser,
and other personal needs
- Rest and study
- Private duty or home nursing (Note: a new law authorizes Medicare
coverage for visiting nurse visits for up to 2 hours from a
visiting nurse service attached to a facility that is already
a Medicare provider. Please contact your selected nursing home
for the latest information on its participation.
Medicare Part B pays for:
- Medical costs such as medicine, doctor fees, ambulance
services to a medical facility, x-rays, and other medical services
and supplies considered necessary by a physician (wheelchairs,
walkers, etc.)
IMPORTANT: See restrictions on use
of these benefits.
Medicare Part B does not pay for:
- Any nursing care provided by an accredited Christian Science
nursing facility
- Christian Science practitioner fees
- Ambulance services to a Christian Science nursing facility
Medicare Part A Coverage Schedule, Deductible,
and Co-Payments Back
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It is important to understand that if the healing occurs
in two or three days, that is how long the coverage will last.
We never expect to need extended care because we expect quick
and complete healing. But if the healing progresses more gradually,
there are limits to how long Medicare coverage is available.
Initial Period (first 60 days) Back
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The patient is responsible for the first $1068 (2009) of their
Medicare covered charges which appear on their first bill. Medicare
will reimburse all remaining charges for room, board, nursing
care, and most supplies for a period up to 60 days.
Co-Insurance Period (next 30 days) Back
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Medicare Part A Hospital Benefits will continue to reimburse
some charges for an additional 30 days. During this period,
the patient is responsible for all care costs up to the daily
deductible of $113.50 per day (2009).
Medicare will pay the rest of the eligible daily costs charged
to the patient.
Lifetime Reserve (additional 60 days possible)
The Lifetime Reserve option can be utilized only once in
a lifetime. If a person has used 90 days of coverage and still
needs care that qualifies for Medicare reimbursement, he or
she can elect to use their Lifetime Reserve. Under this Lifetime
Reserve option the patient is responsible for paying the daily
deductible of $534 a day (2009).
MEDICARE PART A - What you pay:
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Initial period: Deductible $1068
Coinsurance Period (next 30 days): $133.50 per day
Lifetime Reserve (60 days possible): $534 per day
To
check on current
rates after 2009, click
here.
Medicare Benefit Period Back
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A Medicare benefit period begins when a facility determines
that a patient's nursing need qualifies
for Medicare reimbursement. As long as the nursing care continues
to meet these eligibility guidelines, Medicare will reimburse
100% of a patient's bill for 60 days (less an initial deductible
- see paragraph above). If the
nursing care continues as eligible for Medicare reimbursement
after these 60 days, there is another 30 days of partial coverage
available during which the patient pays
a daily deductible (see paragraph above)
and Medicare will reimburse the remainder of the bill.
This combined 90 days is generally known as the benefit period.
After this 90 day period of Medicare-eligible reimbursement,
a patient may also choose to use their one-time only benefit
of 60 additional days, called the Life Time Reserve. (Generally
the daily deductible during this period
is greater than most facilities' fees - see paragraph above.)
A patient may qualify again for a new benefit period if all
of the following conditions are met:
(1) the patient has nursing needs that differ in kind from the
first benefit period;
(2) the required care still meets the eligibility requirements
for Medicare reimbursement (see
eligibility); and
(3) more than 60 consecutive days have elapsed since
Medicare-eligible care was needed.
The Medicare Election Process
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To utilize Medicare benefits at a Christian Science nursing
facility, a patient is required to elect to receive care in
a Religious Nonmedical Health Care Institution based on his
or her own religious convictions. A patient needs to sign and
have notarized an election form at the time of admission stating
that the signer desires to use their Medicare benefits at a
Religious Nonmedical Health Care Institution. These forms are
available at both nursing facilities and a notary public is
also often available. The form must be signed either by the
patient, a legal guardian, or someone designated in a Health
Care Power of Attorney. If a patient is unable to sign for himself
and there is no one legally designated to do so, Medicare will
not reimburse any amount of the bill. A spouse or child is not
eligible to sign this form unless designated in a Health Care
Power of Attorney. Please see Advanced Health
Care Directive can avoid this potential problem.
This election can be revoked at any time if for any reason he
or she decides to pursue medical care.
IMPORTANT: Please refer "Restrictions
on Switching Between Christian Science Nursing Care at a Nursing
Facility and Medical Care."
Restrictions on Switching Between
Christian Science Nursing Care at a Nursing Facility and Medical
Care Back
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Medicare restricts switching between Christian Science nursing
facility coverage and medical care coverage of any sort. If
Medicare benefits are used for any medical purpose, (such as
obtaining a wheelchair, removal of a cast, ambulance services,
or even removing ear wax or cutting toenails), the Christian
Science election is automatically revoked.
The first time an election has been revoked, you are entitled
to execute a new election when you are readmitted to the Christian
Science nursing facility and you will be immediately eligible
for Medicare benefits. It is suggested you speak with the administration
at Broadview or Sunland on how to obtain these services without
revoking your Christian Science election.
If you revoke the second election, you must wait one year before
a third election will become effective.
This does not mean you cannot receive care at a Christian Science
nursing facility; it only means that Medicare will not pay for
that care. Switching three times or more requires a wait of
five years before an individual is allowed to receive Medicare
reimbursement again in a Christian Science nursing facility.
Use of Medicare benefits for covered care in a medical facility
is available at any time.
Although Health Maintenance Organizations (HMOs) are legally
required to honor the use of Medicare benefits at a Christian
Science nursing facility, prior written authorization from the
HMO is usually required. If such authorization cannot be obtained,
the patient may have to withdraw from the HMO in order to reinstate
Medicare benefits that cover care in a Christian Science nursing
facility.
Documents Needed When Entering a Christian
Science nursing home: Back
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- Medicare card
- Social Security card
- All insurance cards
- Current photo ID card (driver's license, passport, or senior
ID card issued by the state)
- Copies of any legal documents providing for a Power of Attorney,
Conservator, or Advance Health Care Directive
Additional Information on Medicare:
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More information on Medicare can be obtained from most Christian
Science nursing facilities. You can also access a highly informative
booklet,
Medicare and its Provision for Religious Nonmedical Healthcare
for Christian Scientists at Arden Wood's website.
For information on enrolling in Medicare, replacing a lost Medicare
card, and general questions about Medicare, call the Social
Security Administration at 800-772-1213. For additional information
on Medicare, Medigap policies, programs that help pay health
care costs, or to request publications, call Medicare at 800-633-4227.
Note: If you talk to Medicare or Social Security about benefits
at a Christian Science nursing facility, it is extremely important
to communicate that you are talking about Hospital Benefits
in Part A of Medicare covered under Religious Nonmedical Healthcare
Institutions and not Skilled Nursing Facility benefits.
We gratefully acknowledge the assistance of Arden Wood and High
Ridge House in the preparation of this document and others for
their help in updating the information.
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