Does Medicare Cover Long-Term Care?

At some point, a beneficiary living on their own may become unsustainable. Whether it’s due to illness or old age, it can happen to the best of us. Medicare can help cover many of their health care needs. While this coverage can lessen many of the health care costs they face, it does not help with all of them. What if they experience an unexpected health event and require care for an extended period of time?

Medicare.gov defines long-term care as “a range of services and support for your personal care needs.” Many times, long-term care is for assistance with everyday tasks. These services are not considered medical care; instead, they are considered custodial care. With that in mind, does Medicare cover long-term care?

Does Medicare Cover Long-Term Care?

Most of the time, the answer is no, especially if a beneficiary only needs custodial care.

Medicare will not cover long-term care simply required for help with activities of daily living, like bathing, dressing, eating, and using the bathroom. It also will not help pay for basic health care that most people can do on their own, like administering eye drops. So, if a beneficiary is living in a nursing home or has a home health care provider strictly for help with these types of tasks, it’s likely they will be responsible for paying for them on their own. That’s not to say that Medicare is completely useless in helping to pay for long-term care.

What’s Covered?

Medicare generally helps cover medically necessary long-term care support. One example of this could be skilled nursing facility care. When they become medically necessary, Medicare Part A may cover a beneficiary’s meals, a semi-private room, and prescription drugs, among other things. They would not have to pay anything for days one through 20 in the skilled nursing facility. After 20 days, they would pay a $167.50 coinsurance each day up until, and including, day 100. After 100 days, they would pay for all costs.

Besides select nursing home care, Medicare also helps pay for care in a long-term care hospital and certain home health services. Additionally, there are programs that Medicare offers that may cover certain long-term care services — if a beneficiary qualifies. These programs are hospice care and PACE.

To get hospice care or join PACE, a beneficiary’s doctor needs to approve either service. Neither of the programs are permanent solutions, though. Hospice care is usually only for individuals who have a life expectancy of six months or less. Should a beneficiary outlive that diagnosis, they can be recertified as needing care. In some cases, PACE’s long-term care benefits may not be premium-free. Unless they are also enrolled in Medicaid, they will be expected to pay premiums for PACE long-term care benefits.

What Are My Other Coverage Options?

Since Medicare cannot cover long-term care, it may seem difficult affording these services. However, beneficiaries still have plenty of options.

If they have the money, they can rely on their own personal savings. This makes a smart savings and funding plan for their retirement especially important. If a beneficiary has a health savings account (HSA), they can use money from that to cover qualifying long-term care services. Another option is using money from their Medicare Savings Account (MSA), if they have one. These are high deductible Medicare plans with a connected banking account that they can use to pay for medical costs. Many MSA plans will help cover long-term care costs covered by Medicare and some not covered by Medicare.

It may also be worth investigating whether a beneficiary qualifies for Medicaid, and, if so, whether they are eligible for long-term care coverage. Eligibility requirements for Medicaid can vary from state to state. To qualify for long-term care coverage through Medicaid, they must be enrolled in the program and meet functional standards as certified by a state medical specialist. One such coverage program that we mentioned earlier is PACE, their long-term care services may also be covered. Certain long-term care services may also be covered by other programs through Medicaid, depending on eligibility.

Another way beneficiaries can afford long-term care is if they have long-term care insurance. Different forms of long-term care insurance are offered by many reputable companies. These types of plans are designed to cover many of the long-term care expenses they may incur in the future. Each plan is different, though, so they will want to read the fine print before enrolling. Some long-term insurance plans will cover everything from skilled nursing home care to adult day care to home health care. When deciding on one, it’s important to consider the cost (since most plans have premiums), their needs, and what the plan covers.

Looking to learn more about long-term care and beneficiaries’ options? Check out LongTermCare.acl.gov. This website, managed by the U.S. Department of Health & Human Services, has a large library of resources and guides on long-term care, from planning tips for the services to finding services. Even though Medicare doesn’t directly cover long-term care, there are many options out there to help.

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