A frequently asked question we get here at Pine Hills Retirement Community is “why don’t you take Medicare?” with the follow-up arguments that nearly 96% of American seniors have Medicare coverage for their long-term care needs. While we can certainly understand and validate your concerns, there are some misconceptions about what choosing to opt out of Medicare means for the residents and families we care for. Today, we’d like to take a moment to address this decision and how it actually benefits our residents, their family, and our staff.

First, let’s discuss Medicare coverage and retirement community living.

Medicare does cover a portion of skilled services — recovery, part-time or intermittent skilled nursing care, occupational therapy, physical therapy, speech therapy, social services, and a portion of medical supplies and durable medical equipment (DME) — which is just a very small portion of what we offer our clients. For these services to be covered under Medicare plans, patients only qualify for skilled nursing and therapy on additional coverage plans beyond the basic Medicare coverage. For instance, under Medicare coverage, you would not qualify to have in-home occupational therapy by itself. You would have to qualify for intermittent skilled nursing with occupational therapy. Medicare does not cover any retirement living expenses including luxury retirement options or independent living. While Medicare plans do offer some coverage for assisted living and long-term care, the services offered at Pine Hills Retirement Community are much more than the basic medical care Medicare will cover. For more information about what Medicare does and does not cover, visit the Medicare site online today. https://www.medicare.gov/what-medicare-covers/what-part-a-covers/what-are-my-other-long-term-care-choices

At Pine Hills Retirement Community, we are not primarily a medical care facility, but a luxury retirement community that meets the medical needs of our residents as their needs change. We offer a wide variety of services that support the total well-being and health of our residents that are not covered under Medicare, including:

  • Fine dining
  • Outings and activities
  • Social events
  • Independent living
  • Assisted living
  • Memory care
  • And, more!

How Opting-Out Benefits Pine Hills Residents

Better patient care.

Medicare has very rigid rules that limit the care of patients to strictly what is medically necessary, without the consideration of the holistic wellness and comfort of residents. For instance, while Medicare does cover occupational therapy that will help stroke victim rehabilitate their own functional capabilities over time, it does not cover personal care assistance in the transition. What this means is, that if we adhered to Medicare guidelines, our occupational therapists could show you how to use special eating tools with limited movement in your dominant hand, we would not be able to assist you with feeding while you are in recovery. Opting out allows our providers to offer a full range of care and services to our clients, including personal care and those services that are for support and comfort rather than clinical recovery. Additionally, because Medicare only covers a portion of the cost, care providers working in Medicare facilities must take on more clients to make a livable wage. This means providers must split their time, attention, and quality care between more clients, reducing the quality and attentiveness for all clients.

Personalized Care

For facilities that take Medicare, they are restricted to rigid rules and checklists provided by the federal government that dictates what type of care and services are necessary. Any deviation from the plan may result in failure to fund any care rendered. At Pine Hills Retirement Community, we believe in individualized care and treatment based on the goals and wishes of our residents because you are more than a diagnosis or life event. By not taking Medicare, we are able to provide treatment that is in your best interest, not your diagnosis’s probable prognosis.

Pine Hills is a Retirement Community

While we do offer assisted living, long-term care, and end-of-life care in addition to memory care for our residents who require it, our primary function is to serve as a comfortable, luxury retirement community in Hot Springs, SD. Our campus is dedicated to fostering an environment that promotes relaxation, comfort, and wellness. We strive to provide our residents with all the comforts and conveniences that allow them to enjoy their golden years and delay the need for medical intervention. Since our primary focus is not medical, we steer clear of operating under any agency or entity that would drive a change toward becoming such. To learn more about our services and what financing options we do offer, connect with us online or call one of our friendly representatives today!