Does Medicare Cover Long-Term Care

Does Medicare Cover Long-Term Care – Overview?

Many people will need to use a long-term care facility later in life. However, there is still considerable doubt about whether Medicare covers it.

This is especially true if you or your loved one have Medicare insurance coverage. This article will help you.

What Types Of Long-Term Care Does Medicare Cover?

Before enrolling in Medicare, it is important to learn about the different types of long-term care. Long-term care usually refers to several services that 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
Audiologists
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 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 – $For 2024, the skilled nursing facility coinsurance for days 21-100 is $$ 204 per day of each benefit period.
Post 100 days – Part A stop payment and you will have to bear the complete cost of SNF services.
Part A deductible – For 2024, the Medicare Part A deductible that beneficiaries pay when admitted to the hospital is $1,632 per benefit period.

Medicare Supplement (Medigap) can help cover Part A co-insurance and other out-of-pocket costs. Medicare Advantage (Part C) offers alternative ways to receive your Medicare benefits, which may include additional coverage.

Don’t forget to buy these plans when buying your Medicare insurance policy.

In-Home Care

In-home care means getting healthcare services at home instead of at the doctor or the hospital.

Home health care agencies usually offer this service. 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. Medicare does not cover cleaning, meal preparation, and custodial care costs.

Beneficiaries may be responsible for 20% of the Medicare-approved amount for durable medical equipment under Medicare Part B.

However, you may need to pay around 20% of the cost of any durable medical equipment (DME), such as walkers, wheelchairs, etc.

Hospice Care

Hospice care is a special healthcare service provided to the terminally ill. Its purpose is 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 a 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.

Medicare does not cover room and board in most hospice settings or treatments intended to cure your illness. Still, it does cover palliative care medications and support for symptom control and pain relief.

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 65 or older, or qualifying through disability or specific conditions like ALS (Lou Gehrig’s disease) or End-Stage Renal Disease (ESRD).
Having a medically proven disability
Having end-stage renal disease (ESRD)

Once you fulfill these criteria, you are eligible to enroll in 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.

Your doctor should also provide documented proof of your daily inpatient care at an SNF. Usually, patients are entered into an SNF within 30 days of leaving the hospital.

The three-day qualifying hospital stay must be as an admitted inpatient; time spent under observation status does not count toward the three-day requirement.

In-Home Long Term Care

If you have original Medicare, you qualify for in-home coverage for long-term care. However, 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 for occupational therapy, physical therapy, etc.

Hospice Long-Term Care

To get Medicare coverage for long-term care at a hospice, you will need to fulfill the following requirements:

Being certified as terminally ill means 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

Does Medicare Cover Long-Term Care – 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. Some Medicare Advantage plans now offer expanded supplemental benefits that may include limited coverage for personal care services, adult day care, and other long-term care support 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. To qualify for PACE, you must be age 55 or older, live in a PACE service area, be certified by your state as needing nursing home-level care, and be able to live safely in the community with PACE services.
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 for more details.

Conclusion

Medicare does cover some types of long-term care services, including in-home care, short stays at SNF, and hospice care.

Fulfill the specific requirements to enjoy these benefits. To learn further details, contact your nearest Medicare office or the local Medicare representative.

Grants for Medical

Does Medicare Cover Long-Term Care