I Thought Medicare Covered Long Term Care?

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Toni:

            Recently in your Medicare column, you discussed services that are not covered by Original Medicare such as dental, vision, long-term care, and other items. I thought Medicare covered long-term care but was wrong because my mother suffered a severe stroke, and her rehab facility notified me that Medicare is not paying for my mother’s care. Beginning next week for her to receive care from this facility, it will have to be private pay, or she will have to go home.

I need some help to understand this confusing Medicare system. What is the difference between rehab/skilled nursing care and long-term care? I thought they were both the same!! Thanks for your help.

Thank you,

Sue

Hi Sue:

            It is very frustrating to understand the rules of Medicare when a loved one has a severe illness and requires both medical and custodial care. I will try and explain what long term care is in simple terms. People are living longer today and want to control the quality of care, especially when they need assistance when their health begins to change.

            On page 56 of the 2024 Medicare & You handbook, it discusses under “Paying for long- term care” and how important it is to plan now to maintain your independence and receive the proper care in the setting you desire. Medicare only pays for medically necessary skilled nursing facility care or home health care if you meet certain conditions. Skilled nursing has 100 days of benefit with days 1-20 having $0 co pay per day and days 21-100 with a specified co pay per day. If you cannot qualify or do not meet Medicare’s qualification for skilled nursing, you will pay 100% of the cost out of your pocket. This is when purchasing a long-term care policy becomes essential.

            Long-term care includes medical and non-medical care for those who have a chronic illness or disability. They may need help with activities of daily living such as bathing, dressing, eating, transferring, continence, ability to use the bathroom or cognitive impairment. At least 70% of people over 65 will need long-term care services at some point. Long-term care can be provided at home, an assisted living facility, personal care home or in a nursing home. Long-term care can be very costly when you begin to seek care. The average cost ranges from $54,000 for a 1 bedroom assisted living facility to $94,900 for an average nursing home. Original Medicare does not pay for these services.

Below are options to pay for long-term care:

• Purchase a long-term care insurance policy; The younger you are when you purchase a long-term care policy, the lower the premiums will be. Many wait too long and qualifying is not easy because of health issues which keep one from meeting the underwriting requirements. Begin searching for a plan while you are younger and in good health.
• Many life policies have a provision if you need long-term care; you can receive a certain amount of your life policy’s face amount.
• Research what your qualifications are for your specific state’s Medicaid. Verify what must “spent down” to qualify.
• Aid and Attendance benefits with the VA can help Veterans and spouses with long-term care issues. (Currently, my mother is under the Aid and Attendance benefit because my father was in the army during Korean War times.)
• Use personal resources such as savings, IRA, 401K to help pay for a long-term care need.

America is concerned about a chronic illness being their biggest retirement expense if not planned properly. Remember with Medicare it’s what you don’t know that WILL hurt you!

 Email your LTC or Medicare questions to [email protected] or call Toni Says at 832/519-8664 for additional help.

Toni's webinar series is available at www.tonisays.com. Toni's books - the Medicare Survival Guide Advanced edition and the Maze of Medicare is available at www.tonisays.com.

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