Does Medicare Cover Long Term Care – Overview?
Many of us will need to use a long-term care facility later on in life. There is still considerable doubt about whether Medicaid covers long term care.
This is especially true if you, or your loved one, have Medicare insurance coverage. This article will definitely help you.
What Types Of Long Term Care Does Medicare Cover?
Before getting into Medicare cover, it is important to learn about the different types of long term care. It usually refers to several services which are medically necessary for a prolonged period of time.
Some common long term medical care services include:
Skilled Nursing Facilities (SNF)
Skilled nursing facilities provide health and medical-related services through professional and technical staff.
These facilities monitor, manage and treat health conditions. Staff at an SNF usually includes:
- Physical therapists
- Registered nurses
- Occupational therapists
- Speech therapists
Normally, one may need to use SNF when:
- Recovering from a serious health disorder/condition, such as stroke or heart attack
- Needing occupational or physical therapy after a surgery or injury
- Requiring intravenous medications, such as during severe infection or a long illness
Medicare Part A offers to cover the cost of short stays at an SNF, in this way:
- Days 1 through 20 – Part A pays the complete cost of all covered services.
- Days 21 through 100 – Part A pays the complete cost of all covered services, but you will have to bear daily co-insurance payments of around US$ 176 per day.
- Post 100 days – Part A stop payment and you will have to bear the complete cost of SNF services.
Medicare Supplement (Medigap) and Medical Part C (Medicare Advantage) plans cover only some of the costs, which are not covered under Medicare Part A.
Don’t, forget to buy these plans when buying your Medicare insurance policy.
In-home care means getting healthcare services that one receives at home, instead of at the doctors or the hospital.
This service is usually offered by home health care agencies. Medicare Part A and Part B cover the cost of in-home care.
In-home services usually include:
- Physical therapy
- Part-time skilled nurses/hands-on care
- Occupational therapy
- Speech-language therapy
Medicare offers to cover only medically necessary in-home care services. This means that cleaning, meal preparation, and custodial care costs are not covered by Medicare.
Those with conventional Medicare do not have to pay anything for in-home services.
However, you may need to pay around 20% of the cost of any durable medical equipment (DME) such as walkers, wheelchairs, etc.
Hospice care is a special type of healthcare service provided to the terminally ill. This service is meant to manage symptoms and provide additional support.
Some examples of hospice care services include:
- Exams and visits from doctors and nurses
- Short-term in-patient care/medications to alleviate pain and ease symptoms
- Medical supplies and devices such as walkers, bandages, etc.
- Occupational and physical therapy
- Short-term respite care at a nursing home or hospital when your regular caregiver is unavailable
- Grief counseling for loved ones and family members in case of patient’s death
Medicare Part A usually covers the entire cost of hospice care. There are small copays for respite care and prescriptions that you may have to bear.
However, Medicare does not cover the cost of room or board when you are receiving hospice care. Besides this, you may have to pay for medications or treatment to cure terminal illnesses.
This is why it is highly advisable to coordinate with the hospice care team and set an efficient plan.
What Are The Eligibility Criteria For Medicare To Cover Long Term Care?
To receive Medicare benefits for long term care you must be eligible for Medicare Part A and Part B. This is done by fulfilling the following requirements:
- Being over 65 years old
- Having a medically proven disability
- Having end-stage kidney disease
Once you fulfill these criteria you are eligible to enroll with Medicare. This, in turn, allows you to receive Medicare coverage for long term care.
Skilled Nursing Facility Long Term Care
To qualify for coverage for long term care at a skilled nursing facility you should first have a qualifying hospital stay. You should be admitted as an inpatient for at least 3 consecutive days to qualify.
Apart from this, your doctor should provide documented proof of your daily inpatient care provided at an SNF. Usually, patients are entered into an SNF within 30 days of leaving the hospital.
In-Home Long Term Care
If you have original Medicare then you qualify for in-home coverage for long term care. This is only after your doctor classifies you as “homebound”.
This means you are unable to move without assistance. Your doctor may also advise you to receive skilled medical care at home.
These may include the need to undergo occupational therapy, physical therapy, etc.
Hospice Long Term Care
To get Medicare cover for long term care at a hospice, you will need to fulfill the following requirements:
- Being certified as terminally ill, meaning your estimated life span is less than 6 months
- Choosing to accept palliative care instead of treatment to resolve your condition
- Signing a statement that you choose hospice care instead of other treatments
What Are The Alternatives To Medicare For Long Term Care?
Despite offering vast coverage there are several areas of long term care that are not covered under Medicare.
For instance, Medicare doesn’t cover the cost of custodial care, which is a major part of living in assisted living facilities and nursing homes.
To help you cover such additional expenses, here are some alternatives to original Medicare:
- Medicare Advantage – Medicare Advantage plans from private insurance carriers offer additional coverage for long term care services.
- Medigap – Medigap insurance plans can help with co-insurance and copayment costs related to long term care services.
- Medicaid – Medicaid is jointly funded by the federal and state governments and offers affordable healthcare services, which vary from state to state. Some states offer to cover certain costs of long term care services under Medicaid plans.
- Long Term Care insurance – Some private insurance providers also offer specially designed policies for long-term healthcare services.
- PACE – Program of All-Inclusive Care for the Elderly (PACE) is available in some states and covers some costs related to long-term medical care for in-home situations.
- Department of Veteran Affairs (VA) – The VA also helps bear the cost of long-term care for some veterans, so contact your local VA health center to know more details.
Medicare does cover some types of long term care services. These include in-home, short stays at SNF, and hospice care.
Make sure that you fulfill the specific requirements to enjoy these benefits. To learn further details, you can contact your nearest Medicare office or contact the local Medicare representative.