Paying for Long-Term Care

You or your loved ones may be wondering about the ways that a stay in a long-term care facility can be financed. Below is general information on the payment methods offered. For specific information on payment methods, please contact our Social Service Designee or Business Office Manager.

Medicare is a federal program administered by the Center for Medicare and Medicaid Services (CMS). Anyone who has had sufficient work history and has paid into Social Security is eligible. Persons 65 years of age or older or disabled persons may qualify.

Part B covers physician services, related medical services and supplies, outpatient hospital treatment, x-rays, lab tests, ambulance services, physical, occupational, and speech therapies, etc.

Part D covers a drug prescription plan, offering a wide range of providers to choose when enrolling, based on your personal needs. If you or your family member needs to remain in the long-term care facility after a Medicare stay, an alternative payment source must be found.

Eligibility requirements for a Medicare A stay in a long-term care facility include:

• Resident has to have been in the hospital for three midnights within the last 30 days prior to the admission.
  
• Resident must require skilled care, which includes physical therapy, occupational therapy, speech therapy, wound care, specialized nursing care, etc.
  
• Medicare does NOT cover non-custodial care, which consists of receiving basic care and supervision in a long-term care facility, such as, bathing, dressing, meals, medication management, etc.

If the resident remains at the skilled care level, Medicare will pay 100% of the coverage for the first twenty (20) days of skilled care services whether those are in the hospital or in a skilled long-term care facility. On the twenty-first (21) day, Medicare will no longer pay 100% of the coverage. If on the twenty-first (21) day, the resident is still determined skilled care, and if the resident has a Medicare supplement policy (co-insurance), the policy may pay $152.00 a day. (The co-insurance rate changes annually, please check with the Office Manager or your Insurance Agent for the correct daily rate or any other questions that you may have).

We are not affiliated with any HMO plan. We do not participate in them.

Alternative payment sources include:

Individuals who do not qualify for Medicaid because of too many assets would be considered a private pay resident. At Oak Lane, the room and board portion of the month is due upon the day of admission. Prior to this first payment, the month's charges will be submitted to you or your representative on the first of each month. Full payment is to be made by the tenth of each month. If the payment is not made within thirty (30) days, 1.5% interest per month will be charged. If the account remains unpaid for more than 90 days, 3% interest per month will be charged. In addition, any days not used in the month due to discharge or death will be refunded to the resident or the resident's representative.

We regret the need to raise room rates on occasion; however, increased cost does require occasional room rate increases. You or your representative will be notified thirty (30) days in advance of any room rate increase.

If you require hospitalization or want to make a home visit, you may hold your bed by paying 75% of the room rate while you are away.

Based on staff availability, if you need us to transport you to your doctor, you will be charged $50.00 for the use of our vehicle, and $10.00 an hour for any staff who assists you.

    1. Prescription drugs as billed by the pharmacy (Medicare residents are an exception.)
    2. Blood chemistry and laboratory fees billed directly by a laboratory (Medicare residents are an exception).
    3. Physical, occupational and speech therapies as prescribed by a physician (Medicare residents are an
        exception)
    4. Other charges exclusive to the residents as medically necessary.
    5. Beauty shop/barber shop charges.
    6. Incontinence care.
    7. Supplements prescribed by a physician.

You or your loved one may be eligible for Medicaid upon meeting certain financial eligibility requirements. The maximum amount of assets, including the bank account, is $2,000.00 to be eligible. Contact the Illinois Department of Healthcare and Family Services for more information regarding qualifications. The Medicaid application may be obtained in the Social Service office at our facility.

At Oak Lane, if you are on Medicaid, you or your representative will receive a reminder statement for your portion of your Social Security income or other income at the first of the month. Payment of your portion is requested by the tenth of that month. Lack of payment is determined an abusive or neglectful situation. In this case, by law, we must notify the Department of Healthcare and Family Services.

If you, a Medicaid resident, are hospitalized, the Nursing Home Care Act requires us to hold a bed for up to ten days. After that time period, your representative may choose to continue holding the bed at 75% of the room rate, or we may release the bed to another resident.

Some people have long-term care insurance policies, which pay a certain amount each day for long-term care, based on the person's policy. Check with your agent if you have any questions.

You or your representative, may place up to $100.00 in a personal account, called a resident fund account, with our business office. Money from this resident fund account may be withdrawn upon request during business hours - Monday-Friday, 8:00 a.m. to 4:00 p.m.

Here are some websites that may be helpful: