SIR MANAGEMENT
MEDICARE FACILITIES

Columbus Park Nursing Center, Chicago, IL

Elmwood Care, Elmwood Park, IL

Fairview Nursing Plaza, Rockford, IL

Maplewood Care of Elgin, Elgin, IL

Much has been written and discussed lately about the Medicare program: possible changes, program reductions and such. Medicare can be confusing for the general public to understand, it has many rules governing its services. This page has been written to help people understand Medicare, its coverage and how to access these programs.

Medicare is a federal government program of health insurance. This program is designed to assist people age 65 or older and some disabled individuals under the age of 65.
To be eligible for Medicare you must be eligible for Social Security or Railroad Retirement benefits. There is no financial requirement nor cut off, you receive Medicare benefits no matter what your income or financial situation.

There are codes on your Medicare card which inform providers of your coverage. They are as follows:

There are two parts to Medicare coverage: Part A - which is often referred to as Hospital Insurance (however, it covers more than hospital stays) and Part B - which is often referred to as Medical Insurance (this covers Doctor charges and other medical services). To understand more about coverage see the Medicare Chart included in this informational page. Skip to Summary

Medicare Part A coverage comes with your eligibility for Social Security or Railroad Retirement benefits; to receive Part B benefits an individual must pay a monthly premium.

There is a Deductible which is an initial amount the individual is responsible for paying before Medicare coverage will begin.

There are Co-Pays which are dollar amounts or percentages of covered expenses which the individual is required to pay.

Medicare

Medicare Part A - Also see summary below...
"Hospital Insurance"

Type of Service Requirements Time Limit You Pay Medicare Pays Not Covered

Hospital in-patient
Semi-private room accommodations, meals and regular nursing services. Includes drugs, supplies, appliances, equipment and ordinarily furnished laboratory and X-ray services.
65 and over, eligible for Social Security; under 65, if having a valid HIC number, in a participating hospital certified by Medicare. First 60 days $776 Balance Private-duty nurse, first 3 pts. of blood, all services covered by the Medical Insurance part of Medicare. (See Medicare Part B Below.)

$194 a day

Additional Lifetime Reserve Available for Hospital Stays Only Lifetime limit 60 days $388 a day

Post-Hospital
Skilled care facilities, that are certified by Medicare
Must occur within 30 days after a minimal 3-day hospital confinement. Must be a condition requiring daily skilled nursing care or skilled therapy services. First 20 days Nothing

100%

Same as above and all personal convenience items such as barber, beautician, personal laundry, private telephone and television. (See Medicare Part B below)

Next 80 days of continuous post-hospital care. $98 a day Balance

In-Patient Psychiatric Same as Hospital In-Patient Services but with 190 days of care in lifetime.

Type of Service	Requirements	Time Limit	You Pay	Medicare Pays	Not Covered
Hospital in-patient Semi-private room accommodations, meals and regular nursing services. Includes drugs, supplies, appliances, equipment and ordinarily furnished laboratory and X-ray services.	65 and over, eligible for Social Security; under 65, if having a valid HIC number, in a participating hospital certified by Medicare.	First 60 days	$776	Balance	Private-duty nurse, first 3 pts. of blood, all services covered by the Medical Insurance part of Medicare. (See Medicare Part B Below.)
	$194 a day
Additional Lifetime Reserve	Available for Hospital Stays Only	Lifetime limit 60 days	$388 a day
Post-Hospital Skilled care facilities, that are certified by Medicare	Must occur within 30 days after a minimal 3-day hospital confinement. Must be a condition requiring daily skilled nursing care or skilled therapy services.	First 20 days	Nothing	100%	Same as above and all personal convenience items such as barber, beautician, personal laundry, private telephone and television. (See Medicare Part B below)
Next 80 days of continuous post-hospital care.	$98 a day	Balance
In-Patient Psychiatric	Same as Hospital In-Patient Services but with 190 days of care in lifetime.

Medicare Part B - Also see summary below...
"Medical Insurance"

Type of Service Requirements Time Limit You Pay Medicare Pays Not Covered

Services by Outside Providers
See below
Must enroll and pay the current monthly premium. Unlimited $100 Plus 20% of the balance of reasonable charges Balance of reasonable charges See below

Monthly premium $45.50

Type of Service	Requirements	Time Limit	You Pay	Medicare Pays	Not Covered
Services by Outside Providers See below	Must enroll and pay the current monthly premium.	Unlimited	$100 Plus 20% of the balance of reasonable charges	Balance of reasonable charges	See below
Monthly premium $45.50

Services by Outside Providers

Services of Physicians and Surgeons, and reimbursement for cost of artificial eyes and limbs, X-ray therapy, physical therapy, speech therapy, occupational therapy, diagnosis lab and X-ray services, certain ambulance fees, enteral/parenteral nutrition supplies, some medical supplies, medical supplies and drugs administered by a doctor or nurse that can't be self-administered.

Not Covered Under Medicare Part B

Routine checkup, eye glasses, hearing aids, dental work, orthopedic shoes, cosmetic surgery, immunizations except flu, pneumonia and hepatitis B, private-duty nurses, first 3 pts. of blood, prescription drugs and patent medicines.

Summary

As you can see from the above chart, Medicare Part A coverage includes:

2. Extended Care services in a skilled nursing facility (nursing home - SNF)
In order to receive coverage under Medicare, the following conditions must be met:

3. Home Health Services:

4. Hospice Services

And you can see from the above chart, Medicare Part B coverage includes:

2. medically necessary ambulance;

3. physical, speech and occupational therapy;

4. home health services that are certified medically necessary;

5. medical supplies and equipment;

6. transfusions of blood and blood components as an outpatient;

7. outpatient surgery;

SIR MANAGEMENTMEDICARE FACILITIES

Medicare

Services by Outside Providers

Not Covered Under Medicare Part B

Summary

SIR MANAGEMENT
MEDICARE FACILITIES