Medicare and Long-Term Care: What’s Covered and What’s Not

Posted by Sue Zanayed
Estimated Reading Time 1 minute 53 seconds

Medicare provides coverage for a range of medical services. However, one aspect that often causes confusion is Medicare’s limited coverage for long-term care. Let’s discuss what Medicare covers regarding long-term care, along with the importance of planning for these needs.

Medicare Coverage for Long-Term Care

Medicare is designed primarily to provide coverage for acute medical care, hospital stays, doctor visits, outpatient services, and certain rehabilitative care. Unfortunately, it does not provide comprehensive coverage for long-term care, which includes services like custodial care, assistance with activities of daily living (ADLs), and help with bathing, dressing, eating, and mobility.

Understanding Medicare’s Limited Coverage

Skilled Nursing Facility (SNF) Care. Medicare Part A covers skilled nursing facility care, but with specific conditions. After a qualifying hospital stay of at least three days, Medicare may cover up to 100% of the first 20 days in a skilled nursing facility. From day 21 to day 100, there’s a daily coinsurance amount. After day 100, Medicare does not cover any costs.

Home Health Care. Medicare Part A and Part B may cover some home health services, including part-time skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services, if deemed medically necessary. However, this is typically short-term and has specific eligibility criteria.

Hospice Care. Medicare provides coverage for hospice care under Part A, offering comfort-oriented care to individuals with a life expectancy of six months or less. This care is usually provided at home but can also be in a hospice inpatient facility.

The Importance of Planning for Long-Term Care

Given Medicare’s limited coverage for long-term care, it’s crucial for retirees to plan ahead for potential long-term care needs. Here’s why:

• Cost of long-term care. Long-term care, whether in a nursing home, assisted living facility, or through home health aides, can be extremely expensive. Planning helps individuals explore options and make financial arrangements to cover these costs.
• Preserving assets and income: Without proper planning, individuals may have to exhaust their savings and assets to pay for long-term care. Planning can help protect assets and ensure that individuals can pass them on to their heirs.
• Choice and quality of care: Planning allows individuals to choose the type and quality of care they prefer. It’s about ensuring that you receive the level of care that aligns with your preferences and needs.

Understanding Medicare’s limitations in covering long-term care is vital for every individual, especially those approaching retirement age. Planning ahead and considering long-term care insurance or other financial solutions are essential steps to secure the necessary care and maintain financial stability. Discuss your concerns with your financial planning professional and/or your insurance professional, so that you can receive guidance in planning for this crucial aspect of life in your later years.