Medicare

National Christian Science Care Database
Information by and for Christian Scientists

 

Home

HOW TO
ADD INFO

About Us


Applying for Medicare Medicare Part A and B
Accepting or Declining Conditions not Eligible for Reimbursement
Eligibility Christian Science Nursing Care
Part A and Part B
Time Periods of Coverage Medicare Election Process
Restrictions on Switching between Christian Science Nursing Care at a Nursing Facility and Medical Care Documents Needed
Additional Information

Back to Top

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 to Top

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 to Top
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 to Top
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
Back to Top
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
Back to Top
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 to Top
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 to Top
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 to Top
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:
Back to Top

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 to Top
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
Back to Top
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 to Top
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 to Top
- 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:
Back to Top
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.

Back to Top

Notice: Information on this database is for educational purposes only. Information is added daily. Information is subject to change
© National Christian Science Care Database. All rights reserved.
NCSCD.COM is iPhone®, Blackberry®, and other PDA phones compatible.
Notify Webmaster if any link is not functioning or if data is incorrect
.