For most people, paying for health care is a major factor in determining how, when and where to seek and receive care. Understanding different payment options will go a long way toward helping you make the best possible decision. Here is some useful information about the various payment sources accepted by Alaris Health Member Centers statewide.
Medicare is a two–part program underwritten by the U.S. Department of Health and Human Services that provides basic hospitalization and medical coverage for people ages 65 and older. It also serves those younger than 65 with certain disabilities.
While it does not cover long-term care, Medicare generally covers patients who require a period of rehabilitation and sub-acute care following a hospitalization. Patients must have had a hospital stay of at least three nights or that occurred within 30 days of admission to an Alaris Health Member Center. Medicare covers the first 20 days of a rehab stay in full and can cover days 21 to 100 at 80 percent if extended care is required. Patients must meet certain clinical criteria as defined by Medicare in order to qualify for coverage.
Medicare Advantage Plans
Approved by Medicare and run by private insurance companies, Medicare Advantage Plans are managed care plans, like HMOs and PPOs. They require that you use the doctors, hospitals and other health care providers who participate in the plans’ networks; in return, they offer extra benefits such as vision, hearing, dental and wellness programs. Thus, Medicare Advantage members will require authorization by their plans before admission to an Alaris Health Member Center. Your Alaris Health Member Center Admissions Office will work directly with the hospital’s discharge planning staff to ensure that the proper coordination takes place.
Medicare Supplemental Insurance
Medicare Supplemental Insurance, also known as Medigap Insurance, covers either all or partial costs that original Medicare does not pay. Typically, such costs may include prescription drugs, dental care, hearing aids or vision care. Of particular importance to patients who require post-hospital rehabilitation and/or related sub-acute services, coverage may also include Medicare co-payments when a patient’s stay is extended beyond 20 days. Your Alaris Health Member Center Admissions Office will be pleased to provide additional details and verify the extent of coverage with your insurance carrier.
Medicaid is a combined federal-state program designed to furnish a wide range of basic services, including long-term care. In times of financial hardship, Medicaid may also be used to pay your Medicare premiums, deductibles and co-insurance.
To qualify for Medicaid, you will need to contact your local Department of Social Services office for details about eligibility and application requirements. Most Alaris Health Member Centers are Medicaid certified and will gladly help you gain a better understanding of this process.
Long-Term Care Insurance
Many people mistakenly believe that Medicare covers long-term care expenses such as nursing center and home health services. In fact, the program only pays short-term benefits for care in a skilled nursing center and for part-time skilled nursing visits at home. As for Medicaid, it does not generally pay for long-term care at home or assisted living. As a result, if a patient requires extended care outside of a residential long-term care facility, the only solution may rest with his or her ability to pay privately. That is where long-term care insurance becomes a consideration.
Long-term care insurance is designed to pay for sudden, large, continuing health care expenses, whether care is provided in a nursing center, hospice, at home or elsewhere. Policies are sold through licensed insurance agents and brokers and paid for from the policy holder’s private funds. It is important to note that coverage is not limited to elderly care. As such, long-term care insurance may be a consideration for nearly every adult. As you would expect, premiums are considerably higher for older applicants who are at greater health risks.
Other Insurance Plans
Alaris Health Member Centers accept most workers’ compensation, motor vehicle, managed care and commercial insurance plans. Contact the Admissions Office at the Alaris Health Member Center nearest to you for additional information.
Care may be funded directly by the patient through his or her own financial resources. Before admission, we will explain and review pricing and rates thoroughly. Contact the Admissions Office at the Alaris Health Member Center nearest to you for additional information.