Long-Term Care Reimbursement Analysis

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Long-Term Care Reimbursement
Who Covers Reimbursement for Long-Term Care
Long-term care has many funding sources which includes government funding, privet insurance, out-of-pocket payments, and any combination of any of these programs. Privet insurance includes insurance for long-term care and managed care (HMO, PPO, POS). While government funding includes Supplemental security income, Department of veteran affairs, Older American act, Medicare, and Medicaid. With Medicare and Medicaid providing the most funding to long-term care (Pratt, 2016, p. 292-306). If Medicare and Medicaid are the biggest funders for long-term care what services do they cover, who do they cover, and what restrictions are put on the recipeits?
An Overview of the
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Part A covers hospitalization, emergency hospitalization, subacute care, home health, and end of life care depending on the situation. Part B covers Doctors’ visits, and covers subacute, end of life, and in home care that Part A will not cover if the patient qualifies. While part C covers medications and needed medical equipment (Center for Medicare and Medicaid Services, 2014). What Medicaid pays for depends on what state you live in, and what your specific situation is. Universally Medicaid covers hospitalization, day procedures, doctors’ visits, nursing facilities, home care, child health check, nurse practitioners, and transportation to doctors’ visits (, n.d). Medicaid offers different services in each state, but the aforementioned are the mandatory areas of coverage for every state. Medicare is aimed at helping the older population, while Medicaid is aimed at people in every stage of life. But who exactly is covered under which…show more content…
So why isn’t insurance for those sixty-five and older the biggest payer of long-term care? This contradiction to what you would think is a result of the restrictions put on long-term care by both types of insurance. Medicaid only sets the restriction that the person must be over twenty-one, have a medical need (verified by a doctor) for help with their daily living, and the care be given in a Medicaid certified facility. If these requirements are met Medicaid will cover nursing facilities, home health, and some day care facilities. However, each state set their own services so the Medicaid eligible services may be different from state to state (, n.d). Medicare on the other hand does not cover long-term care that helps with the functioning of everyday life. Medicare only covers subacute care weather in your home or a facility. With the requirements being that the facility must be at a Medicare licensed facility, the patient has to be transferred from an acute hospital, the transfer must be prescribed by a doctor, and or the patient must have been released from a hospital stay within the last sixty days (CMS, 2014). Medicaid pays for long-term care users who have difficulty living everyday life, performing everyday activities, and have a lifelong medical disorder needing assistance to function at just about any age. While, Medicare pays for
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