Will Medicare Pay for Long-Term Care?

Welcome to the part two in our Long-Term Care series. Last week we learned that Long-term care encompasses a wide range of services focused on providing help with the activities of daily living (such as bathing, dressing, eating, etc.) Long-term care services can be provided at home, in the community, in an assisted living facility, or in a nursing home.

Many New Yorkers (as many as 70% of those turning 65 today) will require some type of long-term care. In the New York metropolitan area, such care can be astronomically expensive. That’s why it’s important to know your options and plan ahead. This week, we look at one of the biggest sources of confusion for many seniors — whether Medicare pays for long-term care.

Does Medicare Pay for Long-Term Care?
Medicare coverage for someone needing long-term care services is scant. Medicare is a health insurance program that focuses on payment for skilled care needs. Medicare coverage mostly provides for hospital stays, physician visits and durable equipment. Help with the activities of daily living or custodial care is excluded from coverage unless such care also includes the provision of some skilled care component to the patient. That said, when an individual is hospitalized for three days or more and the patient requires some skilled care such as physical therapy or wound care, Medicare pays for days 1 to 20 in full at a skilled nursing facility and then requires a co-pay for days 21-100, which most supplemental insurance policies will cover. On day 101 the patient becomes a private pay resident. It is important to know that the 100-day coverage provision is not a guarantee as at any point in time Medicare can discontinue coverage if it determines that the patient no longer requires skilled care.

When Medicare coverage ends, there are basically two alternatives for continuing needed long-term care: private pay (either out of pocket or through a long-term care policy) or Medicaid benefits.

So What Should I Do?
Plan ahead! When it comes to paying for extended long-term care without spending down an entire nest egg, pre-planning is essential. Medicaid eligibility can be achieved in a variety of ways and we have been helping clients get needed care for over 3 decades. In our next installment of this series, we will take a closer look at Medicaid planning.