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What Does Medicare Cover for Long Term Care


Most long-term care costs are the patient’s responsibility. But, in some cases – limited coverage is available. To qualify for long term care benefits under Medicare, you must obtain 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. Custodial care may not be part of your coverage.

Guidelines for Long Term Care Coverage Eligibility Under Medicare

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 a maximum of 100 days during each benefit period.

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 pays for long-term care for a short time under specific requirements.

Part A covers hospital inpatient care, but you may have a deductible and coinsurance expense for each benefit. 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 can help with costs. 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. Long-Term Care insurance generally pays for what Medicare doesn’t cover.

Does Medicare Advantage Cover Long Term Care?

As of recently some Medicare Advantage plans are offering benefits 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.

But, CMS didn’t make the coverage mandatory – it’s up to the insurance provider to choose the benefits and what programs may include them. Advantage plans are extending coverage even further; 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.

What is the 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 long-term care 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 Long-Term Care Partnership Program eligibility varies among states.

What’s the Difference Between 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. Long-Term Care insurance helps pay for nursing home care, assisted living facilities custodial or personal care, and extended home assistance.

FAQ’s

Can Medicare pay for a caregiver?
Medicare will only cover home care from Medicare-certified agencies. So, this excludes registry nurses, independent caregivers, and private therapists. But, a Part C plan may provide some coverage.
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. But, 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. Part A pays for medical bills in full for the first 20 days. But, Medicare stops paying entirely after 100 days of inpatient care.
How much does Medicare pay for home health care per hour?
Of course, costs can vary between service areas. A nurse, social worker, or therapist could cost $70 to $100 an hour. But, an aide could cost anywhere from $10 to $25 an hour.
Does Medicaid pay for assisted living?
Many state Medicaid programs cover a form of Assisted Living for those eligible. It’s best to contact your local state Medicaid program.

Let Us Help You Find Long-Term Care Coverage!

Medicare Supplement plans are a great way to gain comprehensive health insurance.  Our agents can answer all your questions about Medigap coverage and Long-term care plans. Give us a call at the number above to get started. Can’t call? No problem, fill out an online rate form, and we’ll do the hard parts.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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