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Payment Options

caregiver discussing care plan to the senior coupleAt Allcare & Allied Health Services LLC, we provide different payment options for the convenience of our clients. These payment options include long-term care insurance, private pay, Medicare, Medicaid, insurance, and worker compensation. Learn more about the various payment options available to our clients.

Long-Term Care Insurance
Long-term care insurance policies reimburse policyholders a daily amount (up to a pre-selected limit) for services to assist them with activities of daily living such as bathing, dressing, or eating. You can select a range of care options and benefits that allow you to get the services you need, where you need them.

The cost of your long-term care policy is based on:

  • How old you are when you buy the policy
  • The maximum amount that a policy will pay per day
  • The maximum number of days (years) that a policy will pay
  • The maximum amount per day times the number of days determines the lifetime maximum amount that the policy will pay.

Any optional benefits you choose, such as benefits that increase with inflation. If you are in poor health or already receiving long-term care services, you may not qualify for long-term care insurance as most individual policies require medical underwriting. In some cases, you may be able to buy a limited amount of coverage, or coverage at a higher “non-standard” rate. Some group policies do not require underwriting.

For more information, please visit: http://longtermcare.gov/costs-how-to-pay/what-is-long-term-care-insurance/.

Medicaid
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.

  • How to apply for Medicaid
    Each state has different rules about eligibility and applying for Medicaid. Call your state Medicaid program to see if you qualify and learn how to apply.
  • Medicaid spend down
    Even if your income exceeds Medicaid income levels in your state, you may be eligible under Medicaid spend down rules. Under the “spend down” process, some states allow you to become eligible for Medicaid as “medically needy,” even if you have too much income to qualify. This process allows you to “spend down,” or subtract, your medical expenses from your income to become eligible for Medicaid.
  • To be eligible as “medically needy,” your measurable resources also have to be under the resource amount allowed in your state. Call your state Medicaid program to see if you qualify and learn how to apply.
  • Dual eligibility
    Some people who are eligible for both Medicare and Medicaid are called “dual eligibles.” If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered.

You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan (Part C). If you have Medicare and full Medicaid, you’ll get your Part D prescription drugs through Medicare, and you’ll automatically qualify for Extra Help paying for your Medicare prescription drug coverage (Part D). Medicaid may still cover some drugs and other care that Medicare doesn’t cover.

http://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html

PA WC Coverage Requirements
The requirement to insure workers’ compensation liability is mandatory for any employer who:

  • employs at least one employee who could be injured or develop a work-related disease in this state, or
  • could be injured outside the state if the employment is principally localized in Pennsylvania, or
  • could be injured outside the state, while under a contract of hire made in Pennsylvania, if the employment is not principally localized in any state, if the employment is principally localized in a state whose workers’ compensation laws do not apply, or the employment is outside the United States and Canada,
  • UNLESS all employees are excluded from the provisions of Pennsylvania’s workers’ compensation laws.

Exclusions to the Coverage Requirements:
In Pennsylvania, an employer may be excluded from the requirement to insure its workers’ compensation liability only if ALL workers employed by it fall into one or more of the following categories:

  • Federal Workers
  • Longshoremen
  • Railroad Worker
  • Casual workers whose employment is casual in character AND not in the regular course of the business of the employer.
  • Persons who work out of their own homes or other premises not under the control or management of the enterprise AND make up, clean, wash, alter, ornament, finish, repair, or adapt articles or materials for sale that are given to them.
  • Agricultural laborers earning under $1200 per person per calendar year AND no one agricultural laborer works 30 days or more per calendar year AND/OR the agricultural labor is provided by the employer’s spouse or child(ren) under the age of 18 who have not sought inclusion under Pennsylvania’s workers’ compensation laws by filing an express written contract of hire with the Department of Labor & Industry.
  • Domestic workers who have not elected with the Department of Labor & Industry to come under the provisions of the Workers’ Compensation Act.
  • Sole proprietor or general partners.
  • Persons granted exemption due to their religious beliefs by the Department of Labor & Industry.
  • Executive officers who have been granted exclusion by the Department of Labor & Industry.
  • Licensed real estate salespersons or associate real estate brokers affiliated with a licensed real estate broker or licensed insurance agents affiliated with a licensed insurance agency, under a written agreement, remunerated on a commission-only basis and qualifying as independent contractors for state tax purposes or for federal tax purposes under the Internal Revenue Code of 1986.

NOTE: Unless ALL employees meet one or more of the above exclusions, the employer must insure its workers’ compensation liability, even if the employees are working limited part-time hours or are family members such as a spouse or children.
Questions as to how categories would apply to specific workers should be directed to your personal attorney for interpretation.

Failure to Carry WC Coverage:
In the event an employer is uninsured at the time an employee suffers a compensable work-related injury, the department will pursue reimbursement from the employer of monies paid from the Uninsured Employers Guaranty Fund in relation to the claim. Reimbursement will include costs, interest, penalties, fees under section 440 of the Worker’s Compensation Act and attorney’s fees. The department will also pursue prosecution against the uninsured employer under section 305 of the Act.

In addition, an uninsured employer faces grave civil and criminal risks for failing to maintain continuous workers’ compensation coverage. Not only can the employee sue the employer in tort for work-related injuries or diseases, in which suit the employee may recover amounts in excess of those allowed under workers’ compensation, but the employer and those individuals responsible to act on its behalf may each be criminally charged for each day’s failure to maintain continuous workers’ compensation coverage.

Misdemeanor convictions can result in the potential imposition of a $2,500 fine and up to one-year imprisonment for each day the employer is in violation of the requirement to maintain worker’s compensation coverage. Felony convictions can result in the potential imposition of a $15,000 fine and up to seven years imprisonment for each day the employer intentionally violated this requirement. Further, the employer and those individuals responsible to act on its behalf may be required to pay all benefits awarded by a workers’ compensation judge.
The Bureau of Workers’ Compensation investigates employer compliance with workers’ compensation laws and may initiate the filing of charges against employers and individuals responsible to act on its behalf if workers’ compensation coverage is not continuously maintained.

Further, any individual, including competitors, may seek county district attorney approval to file a private criminal complaint against an employer who fails to maintain worker’s compensation coverage when required to do so.

For more information, please visit: http://www.portal.state.pa.us/portal/server.pt?open=514&objID=552712&mode=2

Private Pay
elderly man happily talking with his caregiverPrivate Pay is a type of payment where the patient’s own resources pay for the care. A contract is signed between the person responsible for payment and the facility. Individuals (future residents or clients) must pay for care with personal funds until money and assets (minus those excluded by law) are expended.

Medicare
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
The different parts of Medicare help cover specific services:

  • Medicare Part A (Hospital Insurance)
    Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  • Medicare Part B (Medical Insurance)
    Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
  • Medicare Part C (Medicare Advantage Plans)
    A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
  • Medicare Part D (prescription drug coverage)
    Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
  • Medicare Part D (prescription drug coverage)
    Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Not sure what kind of coverage you have?

  1. Check your red, white, and blue Medicare card.
  2. Check all other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.
  3. Check your Medicare health or drug plan enrollment.
  4. Call 1-800-MEDICARE (1-800-633-4227).
  5. TTY users should call 1-877-486-2048.

For more information, please visit: http://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html