Medicare and Medicaid

Medicare

As a federally-certified Religious Nonmedical Health Care Institution (RNHCI), Glenmont is eligible for participation in the Medicare program.

Almost all residents of the U.S. and its territories who are 65 or older are eligible for Medicare benefits.  Details about the Medicare program are explained in Your Medicare Handbook, a pamphlet available from Social Security offices. The Social Security laws may be changed at any time. Please contact Glenmont for current information about admission and coverage.

Eligibility for Medicare-covered care at a nursing facility for Christian Scientists

There are several conditions to be met before you can receive Medicare-covered care. 
You must first have a Social Security health insurance claim card (obtained through local Social Security offices).  You must then be admitted to an accredited/certified nursing facility which is participating in the Medicare program (not all do so).  Finally, the nursing facility’s Utilization Review Committee (URC) must determine that your needs require covered care.

Not all Christian Science nursing care in a nursing facility for Christian Scientists is Medicare-covered.  This is a surprise to many Christian Scientists expecting Medicare coverage.

Only Christian Science nursing care that requires the skills, judgment, observation or direct care of Christian Science Journal-listed nurses is covered by Medicare.  Other Christian Science nursing care is not eligible for Medicare coverage.

The URC will periodically review your nursing needs to determine whether or not you continue to be eligible for covered care.

Program Specifics

Medicare coverage in a Christian Science nursing facility is covered under Part A. No other part of Medicare, including Part B, can be used to pay for services at a Christian Science nursing facility.

Part A:  This will cover certain costs of staying at an accredited/certified nursing facility for Christian Scientists:
Nursing care where the services of a Christian Science nurse are required
Standard room and board
Nursing supplies and equipment

The following are not covered:
Care that can be rendered primarily by individuals such as nurses aides, student nurses, and nursing assistants
Rest and study
Personal convenience extras (e.g., hair styling)
Private duty nursing (where a nurse is hired by an individual who has been admitted to a facility)
Christian Science practitioners' fees

(Note: Your Medicare coverage may be adjusted when you have other coverage such as Workers' Compensation, auto liability, or employer group policy coverage.)

How long and how much does Medicare pay?
In order to be eligible for Medicare in a Christian Science nursing facility, the patient must first
sign an "election" form, notifying the government of his or her decision to receive Medicare coverage in a Christian Science setting. The patient may receive up to 90 days of "covered" care.  If the patient needs "covered" care for a longer period, he or she may draw upon lifetime "reserve days." The patient will pay a deductible for the first 60 days of coverage ( up to $992 in 2007).  For days 61-90, the patient must pay a daily coinsurance premium ($248 per day in 2007).  Beginning on day 91, if the patient chooses to draw on the lifetime "reserve days," he must pay a higher daily coinsurance premium ($496 per day in 2007). Before a new Medicare benefit period can begin, 60 days must elapse where no "covered" care is needed.

Medicaid

As a Religious Nonmedical Health Care Institution, Glenmont is also eligible to participate in the Medicaid program. Ohio determines the patient's eligibility for this program, based on a number of factors, but three factors are usually key: the patient is 65 years of age or older, requires care, and has $1500 or less in assets. Younger patients may also be eligible for Medicaid if they are disabled and eligible for Medicaid through SSI. Contact Glenmont for more information on how to contact a case worker for Franklin County, Ohio.