Money makes the world go round, or so they say. Discussing financial matters can be difficult for many people they find talking about money is crass or in poor taste. Preconceived notions about affordability prevent further meaningful exploration of senior care options. Others may not realize they are eligible for benefits and are afraid of being denied. There are many reasons why people can avoid asking difficult, but necessary, questions about healthcare.
This third and final blog in our series focuses on the FAQ’s related to paying for Programs of All-Inclusive Care for the Elderly (PACE). PACE centers are relatively new to the state of New Jersey, so getting the answers to those frequently asked questions is important. It is always best to be fully informed when making a healthcare decision for yourself or your loved one.
Q 1: Who is eligible to participate in a PACE program?
A 1: When enrolling, participants must be 55 years of age or older, require nursing home level of care and must be able to live safely in the community. Participants must live in the PACE service area as well.
Q 2: Who pays for PACE and how much will it cost?
A 2: Oftentimes, understanding government-based websites can be difficult because of the jargon and technical language. It is helpful to boil down this information to its simplest form. There are several ways PACE participation is paid for; Medicare and Medicaid are the largest contributors to the program, but there are other options:
Medicare
The participant can have Medicare as the only source of insurance with either part A or part B separately or combined. There is an out-of-pocket cost due to a long term care premium that is not covered since those participants do not have Medicaid.
Medicaid
These participants have only Medicaid coverage and no other.
Dual Eligible
Includes participants who are covered by Medicare AND Medicaid.
Private Insurance
Includes participants who have long-term care insurance (or other insurance) that pays, either in whole or in part, the long-term care premium.
Private Pay
Includes participants who pay both the Medicare and Medicaid capitation amounts privately out-of-pocket. The program also accepts participants who pay privately.
If you qualify for Medicare, all covered services are paid for by that payer source. If you also qualify for your State’s Medicaid program, you will either have a small monthly payment or pay nothing for the long-term care portion of the PACE benefit. If you do not qualify for Medicaid, participants will be charged a monthly premium to cover the long-term care portion of the PACE benefit as well as a premium for Medicare Part D drugs. In PACE, there is never a deductible or copayment for any drug, service, or care approved by the PACE team. PACE agencies receive a set amount of Medicare and Medicaid funds each month to ensure participant care, regardless of the setting. There is an incentive to keep participants healthy.
Knowing the right questions to ask will cultivate better answers. Better answers are the basis for better decisions and better decisions ultimately allow better outcomes. Obtaining all the facts by getting all the FAQ’s answered will help to achieve the best outcome possible. Contact the caring professionals at Beacon of Life, Program of All-Inclusive Care for the Elderly at 732-592-3400 or by clicking below.