Paying for Healthcare Services

Home Helpful Resources Paying for Healthcare Services

Outlined below is the coverage a patient should expect to receive from Medicare and other agency programs for the following healthcare services.

To access the most current and more detailed information on Medicare coverage please visit Medicare’s website.

If you have questions regarding this information or need additional information, please give us a call toll-free at 877-823-8375 or e-mail us at ask@goldenliving.com.

For a Medicare eligible beneficiary, Medicare Part A coverage pays for a semi-private room, meals, nursing services, rehabilitation services, medications, supplies and durable medical equipment for up to 100 days. For the first 20 days in a nursing home, Medicare covers 100 percent of skilled care with a qualified 3 day hospital stay. From Day 21 through Day 100, the resident must pay a daily co-insurance rate.

Patients who are eligible for the services covered under Medicare Part B will be responsible for an annual deductible plus 20 percent of the total charges for services such as occupational therapy, physical therapy and speech therapy, as well as medical supplies.

For those Medicare beneficiaries with Part B coverage, Medicare helps pay for medically necessary physical, occupational therapy and speech-language pathology services when a doctor or therapist:

  • Sets up the plan of treatment
  • Periodically reviews the plan to see how long the patient will get therapy

You can receive your outpatient services from a participating:

  • Hospital
  • Skilled Nursing Facility
  • Home Health Agency
  • Rehabilitation Agency
  • Public Health Agency

You can also receive these services from a Medicare-approved physical or occupational therapist, in private practice.

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

For those Medicare beneficiaries with Part B coverage, Medicare helps pay for medically necessary physical, occupational therapy and speech-language pathology services when a doctor or therapist:

  • Sets up the plan of treatment
  • Periodically reviews the plan to see how long the patient will get therapy

You can receive your outpatient services from a participating:

  • Hospital
  • Skilled Nursing Facility
  • Home Health Agency
  • Rehabilitation Agency
  • Public Health Agency

You can also receive these services from a Medicare-approved physical or occupational therapist, in private practice.

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

For those Medicare beneficiaries with Part B coverage, Medicare helps pay for medically necessary physical, occupational therapy and speech-language pathology services when a doctor or therapist:

  • Sets up the plan of treatment
  • Periodically reviews the plan to see how long the patient will get therapy

You can receive your outpatient services from a participating:

  • Hospital
  • Skilled Nursing Facility
  • Home Health Agency
  • Rehabilitation Agency
  • Public Health Agency

You can also receive these services from a Medicare-approved physical or occupational therapist, in private practice.

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

For those Medicare beneficiaries with Part B coverage, Medicare helps pay for medically necessary physical, occupational therapy and speech-language pathology services when a doctor or therapist:

  • Sets up the plan of treatment
  • Periodically reviews the plan to see how long the patient will get therapy

You can receive your outpatient services from a participating:

  • Hospital
  • Skilled Nursing Facility
  • Home Health Agency
  • Rehabilitation Agency
  • Public Health Agency

You can also receive these services from a Medicare-approved physical or occupational therapist, in private practice.

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Other Agency Programs

The following government programs also provide coverage for the types of healthcare services listed above. However, Medicaid and the VA have different eligibility requirements that we’ve outlined below.

Medicare Advantage or “Medicare Part C”

Medicare Advantage, sometimes called Medicare Part C, is another healthcare coverage choice you have as part of Medicare. These plans are offered by private companies approved by Medicare, and provide all of your Part A and B coverage except for hospice care. However, original Medicare will provide hospice care even if you are in a Medicare Advantage Plan.

Medicare Part D – Medicare’s Prescription Drug Coverage

To get Medicare’s prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan varies in cost and the drugs covered.

Medigap – Medicare’s Supplemental Coverage

Medigap policies are sold by private insurance companies. They help pay for some of the healthcare costs (“gaps”) that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

Medicaid is a program for eligible individuals and families with low incomes and resources that is operated jointly by the federal and individual state governments.

All states provide Long Term Care services for individuals who are Medicaid eligible and qualify for institutional care. For additional information on Medicaid’s eligibility requirements and its long term care coverage, visit Healthcare.gov

Eligibility requirements vary from state to state. To find out more about Medicaid in your state call the toll free number for your state. A list of toll free numbers can be accessed from this page at Medicaid’s website.

Healthcare benefits like home health and long term care are only offered to certain veterans or to veterans under special situations.

  • Covers long-term care services for veterans, if the individual is at least 70-percent disabled due to a service-related injury or illness. A physician’s authorization is necessary.
  • Covers home health care services for veterans, if the individual is at least 50-percent disabled due to a service-related injury or illness. A physician’s authorization is necessary.

For more information, visit the U.S. Department of Veterans Affairs website.

If you have private insurance through your work or individually, you will need to check with your employer’s benefits manager, or your insurance provider directly to find out what is covered under your policy. Plans vary widely on the healthcare services they cover.