Medicare & Long-Term Care

A Medicare card, with several areas of the card obscured to protect privacy. There are separate lines for Part A and Part B, each with its own date. There are no lines for Part C or D, as a separate card is issued for those benefits by the private insurance company.

According to the Medicare Newsgroup, long-term care is generally not covered by Medicare. Most long-term care is considered to be custodial care  -- nonskilled personal care -- such as help with bathing, getting dressed, eating, and moving around. "Medicare does not pay for custodial care," a Newsgroup release states.

The release also notes that most nursing home care is considered custodial and that it is not covered by Medicare. However, if a beneficiary requires skilled care such as physical therapy or changing a sterile dressing, Medicare will pay for this for a short time after hospitalization. Also, a hospice patient on Medicare may be moved to a Medicare-approved nursing home if respite care is needed in order to give a caregiver a break.

The Newgroup release says that as of 2012, Medicare covers up to 100 days in a skilled nursing facility and the patient receives full coverage for the first 20 days in the facility. From days 21 to 100, the patient pays $144.50 per day, and Medicare pays the rest. After 100 days, the patient must pay the full cost of staying in the facility. However, in cases of cognitive decline the patient may be moved to a nonskilled nursing home for custodial care, and Medicare won't pick up the tab.

If the patient uses all of his or her funds to pay the nursing home bills until only approximately $2,000 remains in the bank, there is the probability of qualifying for Medicaid. At that point, the state will pay the nursing home bill and the person will become a dual eligible – that is, enrolled in both Medicare and Medicaid. The takeaway here, obviously, is that long-term care insurance is a very good idea. However, policies vary widely and this is a complex issue. For more information, visit the National Institutes of Health "Senior Health" page here: http://nihseniorhealth.gov/longtermcare/whatislongtermcare/01.html
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