Medicare and Long-Term Care: What’s Covered and What’s Not

Medicare is a critical lifeline for many Americans aged 65 and older, providing them with access to essential healthcare services. However, there is a common misconception that Medicare covers all aspects of healthcare, including long-term care. In reality, Medicare offers limited coverage for long-term care services, and understanding what is covered and what is not is essential for seniors and their families.

Medicare primarily consists of two parts: Part A and Part B. Part A covers hospital care, skilled nursing facility care, and some forms of home health care. While this might seem like it includes long-term care, there are specific conditions that must be met for Medicare to cover these services. For example, Part A will cover skilled nursing care after a hospital stay of at least three days, but it will only cover up to 100 days in a skilled nursing facility, and the patient must require skilled nursing care to qualify.

Part B covers doctor visits, outpatient services, and preventive care. It also provides limited coverage for certain home health services. However, it does not cover custodial care, which is a critical component of long-term care. Custodial care includes assistance with activities of daily living, such as bathing, dressing, eating, and mobility. Unfortunately, Medicare does not provide coverage for these services.

Medicare Advantage (Part C) plans offer an alternative to traditional Medicare by providing additional benefits and coverage options, but even these plans have limitations when it comes to long-term care. Some Medicare Advantage plans may offer limited coverage for in-home support services, but it varies by plan and may still not cover all the costs associated with long-term care.

So, how can beneficiaries pay for the cost of long-term care that Medicare does not cover? Medicaid, a joint federal and state program, is often the go-to solution for low-income individuals who require long-term care. Medicaid covers a broader range of long-term care services, including nursing home care and in-home care. However, eligibility for Medicaid is means-tested, meaning applicants must meet certain income and asset requirements to qualify.

Long-term care insurance is another option that can help fill the gap left by Medicare. These policies can cover a variety of long-term care services and are purchased by individuals to plan for their future needs. Premiums can be expensive, and eligibility for these policies may depend on a person’s health and age when they apply.

And, of course, there is always the option to self-pay for nursing home care. However, these expenses often quickly deplete an individual’s retirement savings account. Paying for these services out of pocket is generally not advised.

It is essential for beneficiaries to understand Medicare’s limitations when it comes to long-term care. Long-term care services, particularly custodial care, are often not covered by Medicare, and individuals must explore alternative options such as Medicaid or long-term care insurance to ensure they have the necessary coverage to meet their long-term care needs. Planning and understanding the available options are crucial steps for seniors and their families to secure their future well-being.

For more information on this topic, discuss long-term care and Medicare coverage at our next consultation. We can help you explore the limitations of your plan, along with other options that might be available to you.