As we enter our sixties, planning for long-term care becomes increasingly important. Understanding what Medicare covers—and what it doesn’t—can help you and your family make informed decisions about future healthcare needs. While Medicare provides substantial coverage for many health services, its support for long-term care is limited.
Medicare Coverage Basics
Medicare, a federal health insurance program for individuals 65 and older, has several parts.
- Part A: Hospital Insurance. Covers inpatient hospital stays, care in a skilled nursing facility (SNF), hospice care, and some home health care.
- Part B: Medical Insurance. Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
- Part C: Part C: Medicare Advantage Plans. Offered by private companies, these plans provide all Part A and Part B coverage and may include a Prescription Drug plan.
- Part D: Prescription Drug Coverage. Helps cover the cost of prescription drugs.
Long-Term Care Coverage Under Medicare
Medicare covers some aspects of long-term care but does impose some significant limitations.
- Skilled Nursing Facility (SNF) Care: Medicare Part A covers up to 100 days in an SNF following a qualifying hospital stay of at least three days. The first 20 days are covered in full, but days 21-100 require a daily co-payment. After 100 days, Medicare provides no coverage.
- Home Health Care: Medicare covers home health care if it is medically necessary and ordered by a doctor. This includes part-time or intermittent skilled nursing care, physical therapy, and other services, but not full-time long-term care or custodial care (help with daily activities like bathing and dressing).
- Hospice Care: Medicare provides comprehensive hospice care coverage, including medical and support services, for individuals with terminal illnesses.
What Medicare Does Not Cover
Medicare does not cover long-term custodial care in a nursing home, assisted living facility, or home if that is the only necessary care. Custodial care involves assistance with activities of daily living (ADLs) such as bathing, dressing, and eating.
Exploring Additional Options
Given these limitations, it’s essential to consider other options for long-term care funding.
- Medicaid: For those with limited income and assets, Medicaid can provide long-term care coverage. Eligibility and benefits vary by state.
- Long-Term Care Insurance: Policies are available to cover long-term care services, including custodial care specifically.
- Personal Savings and Assets: Some individuals may need to rely on personal savings, investments, or the sale of assets to fund long-term care.
Understanding Medicare’s limitations regarding long-term care is crucial for effective planning. Consider consulting with a healthcare advisor or financial planner for personalized advice and remember to discuss your concerns with your licensed insurance agent. Contact us for more information.