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What long term care services does Medicare cover?

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Most long term care is not covered by Medicare, if that is the only care you receive. Long term care is also called custodial care and consists of assistance with the activities of daily living. Medicare will cover medically necessary services that you receive in a nursing home or other long-term care facility, however. These include hospital care, doctor services, and medical supplies.

Short-term stays in nursing homes or skilled nursing facilities are covered by Medicare Part A for medically necessary reasons. You have to have been admitted to the facility within 30 days of leaving the hospital, and be in the facility for treatment related to the qualifying hospital stay. You will begin to pay daily coinsurance toward your stay after 20 days and up through day 100. After 100 days in the skilled nursing facility, you will owe all costs.

Qualifying hospital stays include stays while you were an inpatient in the hospital for three or more consecutive days. Time spent under observation status does not count toward the three days. This three-day rule determines whether Medicare will cover your skilled nursing facility stay. If you have a Medicare Advantage plan, the restrictions will likely be different.

Financing Long-Term Care

Long-term care can be expensive, and many people have to dig into their assets, resources, and investments to pay for the services. Fortunately, if these people did not previously qualify for assistance in paying, they may be eligible for Medicare once their resources have diminished. Another alternative is long-term care insurance.

Long-term care insurance can help you pay for skilled and non-skilled care and have a range of coverage from simply nursing homes to assisted living facilities, adult day care, home care, and medical equipment. Coverage may be limited by pre-existing conditions. Veterans and their families may be able to obtain long-term care insurance at discounted rates.

Medicaid has eligibility requirements based on your income and liquid resources. It is a joint federal and state program that assists people with low income in obtaining healthcare. Medicaid pays a large portion of nursing home bills for people in the program. Most nursing homes accept payment from Medicaid. If you do not qualify due to your income, you may be able to “spend down” your assets by using them to pay for healthcare costs such that the net balance diminishes your income to a qualifying level. Even with the help of long-term care insurance, you may become eligible for Medicaid and begin receiving financial relief.
For more information about how Medicare can cover long-term care, reach out an agent with Bobby Brock Insurance.

Justin Brock

Justin Brock

The CEO and President of Bobby Brock Insurance. A nationally syndicated Medicare advisor, best-selling author of Medicare Breakdown: The Alphabet Soup of Medicare, and pacesetter for over 20,000 senior market insurance agents. Featured in many insurance-related publications for his Medicare and Health insurance... Read More »

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