Private Pay: primary funding source for a majority of products and service associated with long-term care. This refers to costs that are born by the individual or his/her family. These services include a wide range of eldercare and long-term care products and services that are not covered by Medicare, Medicaid or insurance. Individuals without long-term care insurance must pay for these services out-of-pocket.

Medicaid: Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your healthcare providers.

Medicare: Medicare is a health insurance program (PDF 886KB) for people age 65 or older, some disabled people under age 65, and people of all ages with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant). Call (800) – Medicare with questions.

Medicare Part A (Hospital Insurance): helps cover inpatient care, for a limited period of time, in hospitals, skilled nursing centers, hospice programs and home healthcare programs. Coverage is also based on the individual’s level of care qualifications.

Medicare Part B (Medical Insurance): helps cover doctor’s services and outpatient care as well as some preventive services to help maintain your health and to keep certain illnesses from getting worse.

Medicare Part C (Medicare Advantage plans like an HMO or PPO): a health coverage choice run by private companies approved by Medicare that includes Parts A and B and usually other coverage such as prescriptions.

Medicare Part D (Prescription Drug Coverage): helps cover the cost of prescription drugs. May help lower your prescription drug costs and help protect against higher costs in the future.

Benefit Period: begins the day you go to a hospital or skilled nursing facility (SNF). The benefit period ends when you haven’t received any hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods.

Deductible (Medicare): the amount you must pay for healthcare or prescriptions, before original Medicare, your prescription drug plan, or other insurance begins to pay. For example, in original Medicare, you pay a new deductible for each benefit period for Part A and each year for Part B. These amounts may change every year.

Formulary: a list of drugs covered by a plan or as prescribed by a healthcare provider.

Long-term care insurance: policies that supplement what is covered by Medicare and/or Medicaid. These policies vary greatly and require that individuals meet very specific eligibility standards before any benefits are paid out. Policies range from those with very specific limits on the amount of coverage (annually or lifetime) and services covered. Some are claim-specific - paying for a specific set of defined services - while others are indemnity type coverage whereby a specified payout is made if eligibility is met. Finally, rates for these programs vary based on the age and health of the beneficiary.

 
I love working at New Vista. Each day is a learning experience when working with such devoted coworkers. Everyone goes out of their way for the residents.
- Susan K.
It's amazing here at New Vista! The admitting personnel, staff, registered nurses and nursing aides made this an easy adjustment for my dad as well as for me.
- John B.

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