At some point in our lives, about 60% of us will need help with with everyday activities like getting dressed and making meals.1

However, Medicare generally doesn’t cover long-term care, whether it’s in a nursing home, assisted living facility or at home.

What is long-term care?

Most long-term care is not considered medical care. Instead, it is called custodial care. This type of care assists with common activities of daily living. This may include help with bathing and dressing, using the toilet, moving from a bed to a chair, incontinence care, taking medications, meal preparation and more.

It’s important to note that while Medicare won’t cover help with daily living activities, it will continue to pay for your medical services such as physical therapy after suffering an injury.

Which types of care does Medicare cover?

Skilled nursing facilities

With registered nurses working under the supervision of a doctor, skilled nursing facilities can be a patient’s home for recovery following an injury or sickness. Skilled nursing facilities could host someone recovering from a stroke or heart attack, or someone going through physical therapy after an injury.

For these covered services, Original Medicare (Part A, hospital insurance) pays the entire cost for the first 20 days. From day 21 through 100, members must pay a daily co-insurance cost, while Medicare covers the rest. After 100 days, Medicare will no longer cover the cost of the stay.

Home healthcare

After spending time in a hospital or skilled nursing facility, a doctor or healthcare provider may refer patients to receive home healthcare. This is a less expensive, more convenient form of care from the comfort of the patient’s home.

Original Medicare does cover some aspects of home healthcare. This includes part-time or intermittent skilled nursing care, such as changing a patient’s surgical bandages, setting up intravenous (IV) medication, or ensuring that patients are taking their medicines. In addition, patients can receive physical therapy or medical social services.

Care that is less than 7 days each week and for less than 8 hours per day for up to 21 days qualifies as home healthcare, PDF. Home healthcare is meant to be temporary.

Hospice care

Original Medicare (Part A and Part B) will cover some of the costs of hospice care for patients who are terminally ill. Medicare can cover nursing care, hospice aides, social worker services and more. Medical treatment to care for a patient’s terminal illness and room and board, among other costs are not covered by Medicare.

How to pay for long-term care?

Long-term care can be a challenge physically, mentally and even financially. Here’s a helpful guide on which kinds of insurance plans cover long term care, and what coverage is available before a patient requires long term care.

Medicare Advantage plans

Some Medicare Advantage plans can include healthcare coverage for short-term or medium-term care. For example, certain Medicare Advantage plans may cover up to 100 days at a skilled nursing facility when working towards a health goal. In addition, there may be coverage for home healthcare services. However, in general, these Medicare Advantage plans do not cover long-term care.

Medicare Supplement (Medigap) insurance plans

In general, Medicare Supplement plans don’t cover long-term care or care longer than 100 days. However, Medicare Supplement plans, PDF can help cover costs that Original Medicare doesn’t cover. For example, Medicare Supplement plans can pick up the cost of daily coinsurance when staying at a skilled nursing facility from day 21 through day 100. Medicare Supplement plans can be purchased in addition to signing up for Original Medicare, though they don’t provide any additional coverage to Medicare Advantage plans.

Long-term care insurance

If a patient qualifies, he or she can purchase a long-term care insurance plan. These plans can provide financial reimbursements to help pay for custodial care, such as bathing, eating and getting dressed. However, these insurance plans are limited and may not be available to patients already suffering from a chronic illness.

Veterans Affairs benefits

The U.S. Department of Veterans Affairs (VA) can cover some costs of long-term care if a patient qualifies. Patients must be signed up for VA health care and be able to show that they need long-term care for their current condition. The VA can cover some costs of services such as nursing or medical care, physical therapy and custodial care.

Medicaid

In most cases, Medicaid can cover most of the cost of long-term care. This includes services at nursing facilities and at home. What Medicaid covers is both medical care and custodial care. In order to be eligible, patients must meet specific requirements that differ state by state.

Personal savings

If patients have enough money saved up, they can use personal funds to pay long-term care costs. There are also some creative ways to pay for some or all the costs of long-term care out of pocket, including setting up a trust, annuity or reverse mortgage.

Sources

  1. “What is Long-Term Care (LTC) and Who Needs it,” LongTermCare.gov, last accessed June 8, 2022, https://acl.gov/ltc.

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