Medicare and long-term care may go hand in hand, but not always. A large portion of long-term care doesn’t include medical services.
When the only assistance you need is custodial care, Medicare doesn’t pay the expense.
However, there are situations when Medicare does cover long-term care. Before benefits begin, you must meet Medicare’s requirements.
A common misconception is that Medicare pays for all and any long-term healthcare needs. That’s not the case; you may be facing extensive out-of-pocket medical bills for proper care.
Medicare Long Term Care Facilities
Most long-term care expenses are the patient’s out-of-pocket responsibility. But, in some cases – limited Medicare coverage is available for long-term care services.
To qualify for Medicare long term care eligibility, you must receive treatment at an approved facility. After meeting requirements, Medicare may pay for a short-term stay in a skilled nursing facility.
Part A always pays for hospice care if you’re not looking for further treatment and have a terminal illness. Part A covers any drugs given during hospice care and other support from any Medicare-approved hospice facility.
What is a Long-Term Care Facility
By definition, a long-term care facility is a place that provides therapeutic, rehabilitative, and ongoing skilled nursing care.
Patients or residents are those who need help with daily living activities such as bathing, dressing, and personal care.
There are different types of facilities that provide long-term care, such as assisted living residences or nursing homes.
Does Medicare Cover Long Term Care
Custodial care may not be part of your coverage.
Medicare long term care eligibility is attainable under the following conditions when hospitalized:
- You must be an inpatient at an approved hospital for at least three days
- After being admitted to a Medicare-certified nursing facility within 30 days of your inpatient hospital visit
- You must require additional therapy such as physical or occupational
- Your condition medically demands skilled nursing services
Medicare long term eligibility starts after meeting these requirements and pays for part of the costs for a maximum of 100 days during each benefit period.
Paying for Long Term Care
Part A covers hospital inpatient care, but you may have a deductible and coinsurance expense for each benefit. In 2020, the Part A deductible is $1,408, which you’re responsible for paying.
During days 1-60 of inpatient care, Part A has a $0 coinsurance cost. Although coinsurance cost jumps significantly after that, days 61-90 will cost you $352 per day.
After the 90th day, your “lifetime reserve days” begin. Coinsurance increases again up to $704 per day past 90.
However, you only have 60 total lifetime reserve days. Medicare stops covering the costs once you exhaust your lifetime reserve days. Meaning, you’re responsible for ALL costs of long-term care.
Other programs and health insurance may help make LTC more affordable. For example, Medicaid aids low-income individuals or families to help with healthcare costs.
The Medicaid program is the largest payer in the country for long-term and nursing home care. Other alternatives include buying long-term care insurance.
How Does Long Term Care Insurance Work
Private insurance companies sell insurance for long-term care; costs and benefits often vary among plans.
A private nursing home room costs over $250 per day or $8,000 a month. You can imagine how financially exhausting this may become – and fast if you’re unprepared.
However, proper long-term care insurance must meet your healthcare needs. Individual policies may pay for assisted living, informal at-home care, adult daycare, and nursing home services.
LTC insurance generally pays for what Medicare doesn’t cover.
Long Term Care Partnership Program
Four original states pioneered the Long Term Care Partnership Program; terms are different in California, Connecticut, New York, and Indiana.
The program is protection for your lifestyle, income, and assets. Although conventional long-term care insurance is the only type to qualify for Partnership asset protection, without LTC insurance, family or personal assets and income likely pay the hefty medical bills.
The Partnership Program helps keep some of your finances in order when receiving care. However, requirements or LTC Partnership Program eligibility varies among states.
Medicare vs. Long Term Care Insurance
Comparing healthcare coverage, Medicare doesn’t pay for most long-term services. Leaving the costs up to the patient; that’s where Long Term Care insurance is beneficial.
LTC insurance helps pay for nursing home care, assisted living facilities custodial or personal care, and extended home assistance.
Average Length of Long-Term Care
There are several reasons a person may need long term care, and age isn’t always the determining factor. However, on average – the length a person uses long term care is generally 22 months.
How Many Days Does Medicare Pay for Long Term Acute Care
Long term acute care is when you need 25 or more days of inpatient hospital service to treat your condition.
Medicare Part A pays for medical bills in full for the first 20 days. However, Medicare stops paying entirely after 100 days of inpatient care.
How Does Medicare Pay for Long Term Care
Aside from the inpatient costs that Part A pays for, Medicare doesn’t cover long term care. Medicare only covers medical costs acquired while in an assisted living community.
The program does not, however, cover the costs of assisted living or custodial care. On the other hand, Medicare may pay for medical services – like the onsite assisted living facility doctor visits.
Medicare pays for long term care for a short time under specific requirements.
Medicare Advantage Long Term Care
2020 is bringing in some significant changes to Medicare benefits. Come January; some Medicare Advantage plans are offering bonuses to help beneficiaries live as independently as possible.
The Centers for Medicare and Medicaid Services made an announcement earlier this year that Advantage plans had the option of offering long term care coverage.
However, CMS didn’t make the coverage mandatory – it’s up to the insurance provider to choose the benefits and what programs may include them.
MA plans in 2020 are extending coverage even farther; benefits may include personal care, meal delivery, transportation, and adult day care services.
One rule of thumb Medicare and long-term care remains consistent, even with the new benefit options.
Medicare nor Medicare Advantage plans include the cost of room and board or assistance with daily living activities in an assisted living facility.
Let Us Help You Find Long-Term Care Coverage!
We’re here for you, give one of our Medicare experts a call today at the number above. Medicare Supplement plans are a great way to gain comprehensive health insurance.
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At MedicareFAQ, licensed agents are ready to answer any questions you may have. Finding the right LTC plan can be difficult, but not when using a Medicare agent.
We help by comparing rates in your area for plans with the coverage you need. Can’t call? No problem, fill out an online rate form, and we’ll do the hard parts.