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Does Medicare Cover Long Term Health Care

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Long Term Care: What Medicare Covers

Prices vary by insurer for the same amount of coverage. Work with an agent who can sell not just quote policies from different carriers, Slome says. A good agent will know which companies will likely accept you for coverage based on your health and give you the lowest price.

Get price comparisons even if youre offered the opportunity to buy long-term care insurance through a group, such as your employer. If youre healthy, you might find a better deal on your own.

Am I Eligible For A Skilled Nursing Facility

To qualify for coverage to stay at an SNF, you must first have a qualifying hospital stay: your stay must last at least 3 consecutive days and be classified as inpatient.

In addition, your doctor must document that you need daily inpatient care or supervision that can only be given at an SNF. Youll typically need to enter the SNF within 30 days of leaving the hospital.

Who Pays For Long

Medicare doesnt pay anything toward the considerable cost of staying in a nursing home or other facility for long-term care.

So who or what does? Here are some options.

  • Private pay: Many individuals and families simply pay out of pocket or tap assets such as property or investments to finance their own or a loved ones nursing home care. If they use up those resources, Medicaid may become an option.
  • Long-term care insurance: Some people have long-term care insurance that might pay, depending on the terms of their policies.
  • The VA: Military veterans may have access to long-term care benefits from the U.S. Department of Veterans Affairs.
  • Medicaid: The state and federal health care program that provides coverage to low-income people who qualify pays a considerable portion of Americas nursing home bills. Medicaid eligibility varies by state but requires strictly limited income and financial assets.

Many Americans who are in need of long-term care apply after spending down their resources to the point of qualifying. Contact your State Health Insurance Assistance Program for information on eligibility.

Editor’s note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.

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What Is Long Term Care

Long term care is often used as an umbrella phrase to refer to all kinds of assistance to the aging, the elderly, or the disabled, whether that care is given in a patient’s home or in a nursing home. This is an understandable, and common, mistake.

Long term care includes a wide range of support services for patients with a degenerative condition, prolonged illness or cognitive disorder. Also known as “custodial careNon-skilled, personal care for basic day-to-day tasks. This includes help with eating, dressing, getting in or out of a bed or chair, moving around, and using the bathroom.,” long term care primarily involves assistance with daily living or supervision of someone who is cognitively impaired.

The Appeal Of Combination Policies

Does Medicare Cover Long

Aside from the fact that you get something for your premium no matter what, the biggest advantages of combination policies are:

  • The policy can be a good investment if you otherwise would have spent the money or kept it in a low-yield account.
  • You wont have premium hikes when you pay with a lump sum, and a policy with a limited number of payments might even guarantee the premiums will stay the same. Some owners of traditional long-term care insurance policies have seen their premiums double within the past several years as care costs have surpassed insurance companies projections. And with historically low interest rates, insurers havent made enough investment income off of premiums to pay claims.
  • Theres a money-back guarantee with some combination policies. The insurance company will return your premium if you decide you dont want the policy after a certain period of time, such as five years. Before then, you can get a percentage of the premium back.

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Types Of Ltc Insurance Policies

Three types of LTC policies are available in California, named according to where benefits are paid. They are:

  • Home Care Only
  • Nursing Home & Residential Care Facility Only
  • Comprehensive
  • Note: When life insurance or annuity policies include benefits or riders for LTC, they must generally meet the same requirements for each of the types of benefits described below.

    Home Care Only

    Home Care Only policies only cover care in your home or a community setting, but not in an assisted living facility or nursing home. These policies must include benefits for home health, adult day health care , hospice, respite care, personal care and homemaker services.

    Nursing Home & Residential Care Facility Only

    Nursing Home & Residential Care Facility Only policies only cover care in a nursing home or a place licensed as a Residential Care Facility for the Elderly that provides assisted living care. The benefits of these policies must include the cost of all LTC services you receive in the facility not just the charge for room and board up to the policys maximum daily benefit amount.

    Assisted living benefits in this type of policy issued after 1998 must be paid when you are in any RCFE-licensed facility, including small neighborhood homes , retirement homes and specialized community facilities for Alzheimers patients. In addition, the assisted living benefits in these policies must equal at least 70% of the nursing home care benefit.


    Obamacare Medicare And Long Term Care

    We know from the news that people frequently confuse “The Affordable Care Act” and “Obamacare” – even though they are the same thing. In addition, people don’t understand how long-term care, or custodial care, is also covered. Here are some of facts about how long-term care is covered by health insurance programs.

    Who will pay if you need long term care? Many people mistakenly believe their health insurance, whether provided by an employer, bought on an exchange such as Obamacare or Medicare, will pay for long term care. But regular health insurance definitely does not. Medicare sometimes pays for a portion of your long term care but only up to 100 days. And the requirements are very strict, such as requiring a hospital stay for a specific amount of time.

    Okay, so I cant count on Medicare, and regular health insurance wont help at all. What about Medicaid?

    It sounds like Medicaid really is a last resort. So whats left?

    Without Medicaid, there are two ways left to pay for it: Either out of your own pocket, or use long term care insurance.

    The hidden expense when you pay out of pocket

    Tax-free long term care?

    When your long term care insurance pays for care its completely tax-free. You get the full benefit from each dollar and none of it will is diverted to the IRS.

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    Out Of Pocket Expenses

    Medicare will provide a strong health insurance underpinning, but there are some out-of-pocket expenses that you have to cover on your own.

    There is a $148.50 monthly deductible for Part B, which is the portion of the program pays for treatments that are administered by doctors and other health care professionals. The deductible for this coverage is $203, and you have to pay 20 percent of the costs out of your own pocket.

    Part A covers hospitalization, and you do not have to pay a monthly premium for this coverage, but there is a $1484 deductible this year. A coinsurance payment is required for stays that exceed 60 days in duration.

    The prescription drug coverage can be purchased from a variety of providers. There are different coinsurance, premium, and deductible arrangements depending on the specific plan that you decide to use.

    These expenses can be manageable if you plan ahead for retirement effectively, but there is one looming expense that is not easily handled. Medicare does not cover a stay in a nursing home, and it does not pay for in-home care that is provided by a paid caregiver.

    Does Medicaid Cover Long Term Care

    How Does Medicare Cover Long Term Care, Nursing Home Care, and Skilled Nursing Facility Care?

    Medicare recipients who qualify for Medicaid services may have several options available to them for long-term care coverage. While Medicare Part A may help cover the costs of care when admitted into a hospital, skilled nursing facility or home health care services, long term custodial care is generally not covered. Dual-eligibles should carefully evaluate their needs and discuss their options with loved ones and their health care team.

    Common Types of Long-Term Care Providers

    The level of care a person requires will help determine what type of long-term care service they need. Providers may classify the types of care they provide by different terms, but most fit within the definition of the following three terms:

    Providers may include temporary care within the scope of their services, such as day or respite care for recipients who live at home but may need extra support when their family is at work or out of town. Hospice care may also be offered on site or at home.

    Long-Term Care Coverage for Dual-eligibles

    Medicaid can sometimes pay for temporary stays in a skilled nursing facility after a surgery, but there may be limitations related to the length of stay or the type of surgery. Medicaid can also help with costs associated with living in an institutional care facility such as a nursing home, or recipients may be eligible for waivers that allow them to receive home and community-based services while living independently or with family.

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    Emergency Medical Alert Systems

    Emergency response systems automatically respond to medical and other emergencies via electronic monitors. The user wears a necklace or bracelet with a button to push in an emergency. Pushing the button summons emergency help to the home. This type of service is especially useful for people who live alone or are at risk of falling. A monthly fee is charged.

    Talking With Your Parents About Long

    It can be difficult to make the decision about whether you or a loved one needs to leave home. Sometimes, decisions about where to care for a family member need to be made quickly, for example, when a sudden injury requires a new care plan. Other times, a family has a while to look for the best place to care for an elderly relative.

    You may have had a conversation with a loved one where they asked you not to put them in a nursing home. Many of us want to stay in our own homes. Agreeing that you will not put someone in a nursing home may close the door to the right care option for your family. The fact is that for some illnesses and for some people, professional health care in a long-term care facility is the only reasonable choice.

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    Making Decisions About Long

    Begin by thinking about what would happen if you became seriously ill or disabled. Talk with your family, friends, and lawyer about who would provide care if you needed help for a long time. Read about how to prepare healthcare advance directives.

    You might delay or prevent the need for long-term care by staying healthy and independent. Talk to your doctor about your medical and family history and lifestyle. He or she may suggest actions you can take to improve your health.

    Healthy eating, regular physical activity, not smoking, and limited drinking of alcohol can help you stay healthy. So can an active social life, a safe home, and regular health care.

    Medicare Long Term Care Coverage

    What does Medicare cover?

    While Medicare doesnt cover the majority of long-term care costs, there are some expenses that Medicare will pay for. One expense that Medicare long term care may cover is a short stay in a skilled nursing facility. As long as you meet certain requirements, Medicare long term care will cover the costs. These requirements include:

    • You had an inpatient hospitalization admission for at least three days.
    • You checked into a Medicare-certified nursing facility within 30 days of your inpatient hospital stay.
    • If you need skilled care such as professional nursing services, physical therapy, or other types of therapy.

    Medicare long term care may pay for the first 20 days in a skilled nursing facility. After that, youll need to pay $170.50 of coinsurance per day, for up to 100 days. Once you surpass 100 days, youre responsible for the cost of your care.

    Another cost Medicare may cover is short-term skilled nursing care due to an illness. If a medical professional states you need to receive care in your home, Medicare may pay in-home care from nurses and therapists. Medicare may also provide services to help you maintain your life at home. Typically, Medicare limits your care to 28 hours per week. But, with your doctors recommendation, you may qualify for additional attention.

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    How Can I Start Planning For Long

    Now that weve debunked the myth that Medicare covers long-term care , how can you start working on your long-term care plan?

    First, get educated about long-term care options. Youre already doing this by learning the truth about Medicare and Medicaid. Great job!

    Next, figure out which family members and friends might be able to help you when the time comes. While these conversations can be hard, its better to have them well before you actually need the help. And, again, make sure youre not relying on your loved ones for 100% of your care. This is usually not realistic.

    Finally, we recommend getting long-term care insurance when you turn 60 years old. The older you are, the more likely youll be denied coverage. Assess how much care you might need and think about what your expectations are during retirement and beyond.

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    If Medicare Won’t Pay For Long

    Long-term care can be tremendously expensive, and unfortunately, your options for covering it are limited.

    One option is to rely on your own savings or a loan, like a reverse mortgage.Another is to buy long-term care insurance, which is sold by many insurance companies and typically covers things that Medicare wont, such as extended home care, assisted living and nursing home care. The earlier you buy a policy, the more affordable it’s likely to be. The premium becomes more expensive the older you are. You may also be able to trade in your life insurance policy for long-term care insurance. People who have worked for the government or were in the military may qualify for discounted insurance.

    What Medicare Will Cover

    Does Medicare Cover Long-Term Care?

    First of all, let’s take a look at quick Medicare details.

    Medicare is the federal health insurance program for people 65 and older, certain younger people with disabilities, and those with end-stage renal disease .

    To summarize quickly, Medicare has three different parts: Medicare Part A, Part B, and Part D, which refers to the following and covers these specific services:

    • Medicare Part A : Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
    • Medicare Part B : Part B covers certain doctor’s services, outpatient care, medical supplies, and preventive services.
    • Medicare Part D : Medicare Part D helps cover the cost of prescription drugs .

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    Medicare Part A Covers Services Received In Long

    Medicare Part A provides hospital insurance and covers care received in a long-term care hospital . You may qualify for this type of care if you meet the following two requirements:

    • You have more than one serious health condition
    • You may improve with care and time, eventually being able to return home

    You generally must meet your Part A deductible for each benefit period during which you are admitted for an inpatient stay at an LTCH. The 2020 Medicare Part A deductible is $1,408 per benefit period.

    After you meet the Part A deductible, you are responsible for Part A coinsurance payments of $352 per day for days 61-90 of your inpatient stay in each benefit period, and $704 per day for days 91 and beyond in each benefit period until you exhaust your 60 lifetime reserve days.

    When your 60 lifetime reserve days are used up, you are responsible for all costs.

    Let Us Help You Find Long

    Medicare Supplement plans are a great way to gain comprehensive health insurance. Our agents can answer all your questions about Medigap coverage and Long-term care plans. Give us a call at the number above to get started. Cant call? No problem, fill out an online rate form, and well do the hard parts.

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