FINANCIAL CONSIDERATIONS

How to determine cost of care

Financial Factors

There are a lot of things to consider when determining cost of care as an individual ages. Health conditions, family medical history, preventative costs and how you want to live are just a few of the factors in figuring out what your financial plans can cover and what assistance might be needed.

Go into your decisions knowing what your savings are and what kind of coverage your insurance provides. Enrolling in insurance coverage will help ease financial burdens for care.

Virginia Health Services offers a continuum of care, meaning as an individual’s needs change, so can the type of care VHS provides.

Virginia Health Services nursing and rehabilitation centers and its home and community-based services accept Medicare, Medicaid, most commercial insurances and private pay. VHS independent and assisted living communities are private pay only.

INSURANCE OPTIONS

The VHS billing team will work with individuals and families on submitting claims for long-term insurance providers. Be sure to check the Explanation of Benefits (EOB) from your insurance company to understand what is owed for care. There are several tools online that can help individuals determine an estimate for the cost of care.

Virginia Health Services does not make assurances that an individual’s care will be covered by Medicare, Medicaid or insurance companies. Services not covered will be billed to the individual (or responsible party).

Virginia Health Services accepts a number of payment options, including:

Medicare Parts A and B
Medicare Advantage Plans (Medicare C)
Medicaid and Commonwealth Coordinated Care (CCC) Plus Plans
PACE Programs
Most commercial insurances
Veteran’s Administration (Available at Coliseum and Walter Reed Nursing and Rehabilitation Centers for skilled and long-term care)
Managed Care Plans (for those under 65 or still working), including worker’s comp cases
Private pay

NAVIGATING MEDICARE AND MEDICAID

Medicare is administered through the federal government for individuals 65 years and older. There are four sections – A, B, C and D in which you can enroll (outlined below).

Medicaid is available to individuals in lower-income brackets. It is a federal and state program – you must enroll in your locality – and has a series of requirements.

You can be dual-eligible and qualify for both Medicare and Medicaid. A helpful breakdown of both is available at medicare.gov.

MEDICARE

Virginia Health Services accepts Medicare A, B and D, and Medicare Advantage Plans. This can be used with co-insurances. Part A can cover skilled nursing center care, home health care and hospice. Part B can also help cover home health care costs, outpatient care and more. Part C is a series of bundled plans in which individuals can enroll. Medicare Part D is a supplement to an individual’s Medicare coverage to help offset the cost of prescription drugs to those 65 and older. To receive drug coverage from VHS Pharmacy, individuals must be enrolled in a Medicare Part D plan.

MEDICAID

Medicaid is available to individuals in lower-income brackets. It requires a separate application process through your municipality’s social services department. Qualifications depend on income status, state residency and more. Please note, in Virginia Health Services, The Newport Nursing and Rehabilitation Center does not accept Medicaid.

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