Long-Term Care - What About Medicare?

attorney long-term care medicaid medicare michigan nursing home Nov 01, 2016

Today we'll be taking a brief look at some aspects of long-term care. For more detailed information, it’s best to consult with a qualified legal advisor. So think of this as an introduction.

There are many complexities to long-term care planning, it’s important to understand that there are options, and programs intended to help families like yours. Long-term care planning is the best way to ensure you protect as much of your hard-earned assets as the law allows, and to receive the care you need.

Let’s Get Started…

What About Medicare?

A. Hospital and Post-Hospital Skilled Care

  • Contrary to the belief of many seniors, one cannot rely on Medicare for payment of long-term care costs. Although Medicare is available to most individuals age 65 or older, coverage is limited to:  qualified medical expenses (80% of an approved amount for doctors, surgical services, etc.); hospitalization with a deductible of $1,260.00 (total) for the first 60 days and a co-payment of $315.00 per day for days 61 through 90, and an additional one-time, lifetime benefit of 60 days, with a co-payment of $630.00 per day (for a maximum of 60 days); and post- hospital skilled nursing home care with payment in-full for 20 days and a co-payment of $157.50 per day for 80 days (maximum of 100 days).
  • A new pool of 90 hospital days, with new copays of $1,260.00 and $315, only starts after the beneficiary has 60 days continuously with no payment from Medicare for hospital or nursing home.

B. Gaps in Coverage

  • Medicare only pays for nursing home care following a hospital stay of at least 3 days, and only if the care provided is considered “skilled care”.  Skilled care is provided under the supervision of a doctor, requiring skilled professionals such as physical therapists or registered nurses, as opposed to “custodial care”, which provides basic personal care and other maintenance level services.  Home health care may be available in limited amounts, but only if “medically necessary”, which is a very rigorous standard.  For all Medicare benefits there are deductibles and co-payments, which can be substantial, and Medicare is in the process of becoming a “means tested” program.  There are excellent insurance policies available to fill these “gaps” in Medicare coverage, appropriately called “Medigap” insurance, which must be purchased privately. 
  • Medicare does not cover hospital costs beyond 150 days, skilled nursing home costs beyond 100 days and, most importantly, Medicare does not cover any custodial nursing home care or non-skilled home health care. It is difficult for a Medicare recipient to qualify even for the limited “skilled care” benefits, and all others are considered “custodial” patients.  With the Medicare Trust Fund currently projected to fail in approximately 2018, gaps in coverage are widening rapidly.

For more information about the differences between Medicare and Medicaid, Click Here.

Next: What About Paying Your Own Long-Term Care Expenses?

Planning Ahead Can Make a Serious Difference in the Quality of Life You or Your Spouse May Have. Know Your Options.

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The information in this blog is not intended to be, nor should it be, construed as legal advice. It is for informational purposes only. For advice, specific to your situation, consult with a qualified attorney.