Frequently Asked Questions

In order to help you make informed decisions about Assisted Living, Heritage Community of Kalamazoo has developed the following list of Frequently Asked Questions, or FAQs.

What type of Medicare coverage do I have?

Most people have "original" Medicare, which is implemented by the Federal government, which is available to most people when they turn 65. More specific information detailing "original" Medicare is outlined in the questions following. Another type of Medicare coverage are "Medicare Advantage plans". Advantage plans are implemented by a third party insurance carrier or managed care provider. These managed care companies are paid a monthly premium by Medicare to provide health care. Please visit www.medicare.gov for more information.

What does Medicare cover in a skilled nursing facility?

Medicare Part A helps cover 100 days of care at the Harold and Grace Upjohn Community Care Center. Anyone with "original" Medicare will receive coverage for all costs for the first 20 days. After the first 20 days, the next 80 days have a co-insurance amount of $133.50. The co-insurance amount may be covered by a private insurance policy known as a Medigap policy. Medicare Advantage plans offer different amounts of coverage; check with your plan for specific information on your coverage.

Am I guaranteed 100 days of coverage with Medicare?

With "original" Medicare, you have up to 100 days of coverage; in order to remain on Medicare coverage, you must be receiving a skilled service. Some examples of skilled services are Physical, Occupational, and Speech therapy, Skilled Nursing care for acute illnesses and treatments, such as tube feeding, IV, etc.

How do I qualify to use my Medicare benefits?

In order for Medicare to pay, you must have stayed in the hospital for 3 consecutive days, within the previous 30 days from admission to the Upjohn Care Center. You must remain in the Care Center to receive treatment, which means that you cannot be gone overnight.

What is Medicaid?

Medicaid is a health insurance program for those with very low income and/or assets. It is administered by the State of Michigan and requires that a person apply for benefits through their county Department of Human Services. The application is reviewed and a determination of coverage can take up to 45 days. If you need assistance in completing an application, the Upjohn Community Care Center has resources available to assist you with this process, please contact the Upjohn Community Care Center. [need link]

What does Medicaid pay for in a nursing facility?

Medicaid pays for room and board, as well as nursing care. It also serves as a Medigap policy for those who qualify for coverage. Medicaid will pay for x-ray services, physician services, outpatient hospital services, etc. Unfortunately, the state has been forced to reduce coverage for many services that were formerly covered by Medicaid; a caseworker at the Department of Human Services can assist with providing information regarding coverage.

If I qualify for Medicaid, what will I have to pay?

For your stay at the Upjohn Community Care Center, you will be told by Medicaid how much you must pay each month towards your care. This is called a patient pay amount and is usually based on the person's monthly income. You will not be expected to pay for any additional service provided by the Care Center.

How often will my physician visit while I’m at the Harold and Grace Upjohn Community Care Center?

Your physician will visit within the first 3 days of your admission here and then at least every 60 days thereafter. A Nurse Practitioner is in our facility 4 days per week to deal with medical issues as they arise. The Nurse Practitioner is able to write orders for medication and tests for most medical concerns that residents have.