Available Funding Options
Medicare coverage is divided into two parts: Part A (hospital insurance), and Part B (medical insurance). Looking for Medicaid?
What does Medicare Part A cover?
Overall, Medicare Part A helps pay for care in hospitals, skilled nursing facilities, hospice and some home health care. To find out current coinsurance amounts and days covered, please call Medicare toll-free at 1-800-MEDICARE (633-4227).
What Does Medicare B cover?
Medicare B covers 80% of necessary medical services and equipment including: physicians' fees, physical, occupational and speech therapies, durable medical equipment (hospital beds and wheelchairs), x-rays and lab tests.
The Medicare recipient or recipient's supplemental insurance policy must pay a 20% coinsurance amount for almost all items covered under the Medicare Part B program. To find out current premium amounts, please call 1-800 -MEDICARE (633-4227).
The following services are not covered by Medicare Part A or Part B:
- Private-duty nursing
- Custodial care at home
- Most chiropractic services
- Care outside the United States
- Experimental procedures
- Custodial care in a nursing facility
- Most preventive care
There are many other insurance options that cover skilled nursing services not covered by Medicare, including Medigap, Medicare HMOs, supplemental and long-term care insurance. If you are covered by any of these types of insurance, consult your representative.
Medicaid is a Federal as well as a State-funded program that provides financial assistance for medical services to low-income individuals of all ages. Services offered through this program do not require monthly premiums, but there are strict financial eligibility requirements. In addition, Medicaid may require you to pay a portion of your monthly Social Security income to the nursing home as partial payment for services (patient liability). There are different eligibility levels depending on the type of care necessary. Your State Department of Human Services can provide more information on the current State requirements, rules and restrictions.
Medicaid covers the following:
- All care provided in a Medicaid-certified nursing facility
- Home health care including nursing care, physical therapy and related services
- Other home services such as homemakers and chore services
- Physician care
- Hospice care
- Community mental health services
- Prescription drugs
- Some assistive devices including eyeglasses, dentures and hearing aids
- The cost of some Medicare Part A and B premiums, deductibles and CO-payments, depending on your financial eligibility
Medicaid is a program that provides medical assistance to needy persons. It is not a program directed primarily to the elderly, but rather to the poor. It depends on financial need, low income and low assets.
Medicaid is not available to seniors under 65 unless they are blind or disabled.
If someone over 65 lives with an adult child, the child's income and assets do not count in determining eligibility. Only the senior's income assets are counted.
Remember, Medicaid helps needy people pay for medical care. In determining your eligibility for Medicaid they do not look at how much your rent, car payments or food costs. They only look at medical expenses, and these include:
- Care from hospitals, doctors, clinics, nurses, dentists, podiatrists and chiropractors
- Drugs, medical supplies and equipment
- Health insurance premiums
- Transportation to get medical care
At the present time, there are two ways to receive Medicaid:
- Supplemental Security Income eligibility provides Medicaid automatically
- Medicaid spend-down
Spend-down is similar to a deductible or CO-pay amount you must pay before you can receive Medicaid. You must meet the spend-down every month, and once you do meet your spend-down, you are eligible for Medicaid for the remainder of the month.
To qualify for Medicaid, a person must pass four eligibility tests:
1. Categorical Eligibility: Aged 65, blind or disabled.
2. Non-Financial Eligibility: Ohio Resident, Citizen/Alien Status, Social Security Number
3. Financial Eligibility Requirements: Income, Assets
4. Procedural Requirements: Complete and sign an application form, Provide proof of eligibility, Report changes in circumstances
How may we help?
For further assistance or to answer any questions you might have, please contact a member of our team at (419) 253-0144.
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Useful Resource Links
Please note: clicking on the following links will open a new browser window.
Ohio Dept. of Aging
Assist Guide: defines terms related to long-term care