Insurance & Billing

What is Medicare?

Medicare is the federal government’s health insurance program for people age 65 or older and for many people living with disabilities. There are different types of Medicare.

MEDICARE A
This program covers hospital care, skilled nursing and sub-acute inpatient care, home health care, and hospice care.

SKILLED NURSING CENTER (or Sub-Acute Care) COVERAGE
To utilize benefits in a skilled nursing center, Medicare requires a minimum of three (3) midnights in a hospital, and your condition must require skilled services. The maximum benefit period is 100 days.

There is no guarantee of coverage in a skilled nursing center. A resident must meet clinical criteria to qualify for coverage. The coverage can vary from a few days to the full 100 days. It will be up to the clinical team within the facility to assess whether each patient meets Medicare’s guidelines for continued coverage.

Important Points to Remember About Skilled Nursing Center Coverage:
  • The first 20 days are covered at 100%.
  • For days 21–100, if the resident qualifies, Medicare will pay all but the daily co-insurance (most medi-gap policies will cover).
  • The patient must have a three (3)-midnight hospital stay prior to admission into the skilled nursing center.
  • If a patient has used some or all of the 100 days of Medicare time in a skilled nursing center and has returned to the community, he or she must be in the community setting for 60 days, and not receiving a skilled or acute care service, for the full 100 days to be in effect again.
MEDICARE HMO
Many people elect to participate in a Medicare HMO. Although many of the HMO plans’ benefits are similar, each plan varies regarding member requirements. Almost all HMOs require that you receive care from an “in-network” provider.

Overview of Funding Sources

Westport Rehabilitation and Nursing Center participates with most commercial insurance plans, and we are happy to discuss your specific coverage prior to admission. It is also important to know that under most insurance plans, pre-certifi cation is required. Medicare A covers only short-term care in a skilled nursing center. For those interested in long-term care at Westport Rehabilitation and Nursing Center, an application is required to determine the possibility of long-term funding.

OTHER FUNDING SOURCES
There are several other funding sources for short-term and long-term care. These options include:
  • Insurance: If you are under age 65, your health insurance will most likely include benefits for skilled nursing care.
  • Private Pay: Patients have the option of paying privately for their stay in a skilled nursing center if they have exhausted their Medicare coverage or if their insurance does not include a skilled nursing benefit.
  • Long-Term Care Insurance: For long-term care, many residents have purchased private policies to cover their stay. Each policy and plan varies in benefits and coverage.
  • Medicaid: Medicaid is the state program for long-term care funding. Individuals must financially and medically qualify for this program.
For more information regarding your insurance benefits, please contact our Admissions Office at (804) 288-3152. You can also contact Virginia’s Health Insurance Counseling and Assistance Program through the League of Older Americans at (540) 345-0451.

Stay A Little Longer, Get A Little Stronger

As one of our residents, you might like to know about a special program for those who need additional time to gain strength and independence before returning home. Medicare has covered your rehabilitation stay; however, you may not qualify for continued Medicare coverage although you may still be in need of continued nursing support.

That is why we have developed our “Stay A Little Longer, Get A Little Stronger” program. Whether you need a few weeks or a few months, we will provide you with the health-care services and the TLC that you need to ensure the safest possible discharge to home.

One benefit of the “Stay A Little Longer” program is that it can be more cost effective than privateduty, at-home nursing care. The cost for the program is the same as our semi-private room rate, and we will bill your Medicare B or supplemental insurance for additional services covered by these insurances. If you do not have supplemental insurance, you can be billed privately.

Services Offered Include:
  • 24-Hour Nursing Supervision and Care
  • Medication Management
  • Personal Care Assistance
  • Rehabilitation Therapy Services
  • Patient/Family Medical Treatment Education (diabetes counseling, wound care, etc.)
  • Three Meals Per Day Plus Snacks
  • Social Services and Discharge Planning
  • Nutritional Monitoring and Planning
  • Spiritual Services
  • Full-Service Beauty Salon
For more information about our “Stay A Little Longer, Get A Little Stronger” program, please contact our Admissions or Social Services Director, who will be happy to assist you with the arrangements. Be safe and let yourself recover. If you feel you need more time before returning home, we are here to help!

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