Does Medicare Cover Long-Term Care?

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​Are you approaching retirement? If so, you may be thinking about health care coverage. One of the biggest steps in retirement planning is the transition from employer-based health insurance to Medicare.
 
Medicare is a valuable retirement resource that provides health care protection for 44 million Americans, or 15 percent of the population.1 It covers a wide range of medical services, such as hospitalization, doctors’ appointments, prescription drugs and more. You can utilize Medicare Advantage to obtain flexible deductibles and copays and even supplementary coverage for things like dental service.
 
A number of services aren’t usually covered by Medicare, however. One of the biggest is long-term care. That can be a challenge because long-term care is an increasingly common and necessary service. The U.S. Department of Health and Human Services estimates that today’s 65-year-olds have a 70 percent chance of needing long-term care in the future.2
 
Unfortunately, it’s difficult to plan for long-term care needs because you don’t know exactly what kind of care you will need or whether it will be covered by Medicare. Below are some tips and guidance on how Medicare determines whether care is eligible for coverage. You can’t predict your health care needs, but you can plan ahead if you understand what’s covered and what’s not.

What kind of care are you receiving?
 
Medicare generally doesn’t cover long-term care. However, there are exceptions to that rule. It will sometimes pay for skilled nursing care but usually doesn’t pay for custodial care. That’s an important distinction.
 
Skilled nursing care involves treatment for a specific illness or injury. It’s usually provided in a facility and prescribed by a doctor. While skilled nursing may include some forms of custodial care, such as help with eating or bathing, the purpose of the care should be treatment and recovery.
 
Custodial care is more focused on assistance with basic living activities such as mobility, eating, incontinence and more. The goal of custodial care is usually comfort and lifestyle support, primarily because the individual is at a stage where recovery isn’t an option.
 
If care is more of the custodial variety, it probably won’t be covered by Medicare. That’s usually the case with most long-term care services. Many recipients of long-term care suffer from chronic conditions like Alzheimer’s. Since they’re past the point of recovery, care is more about lifestyle support and maintenance.

Where is the care provided?
 
The way the care is provided is also an important factor. Long-term care is often provided in the home or in an assisted living facility. Those places usually aren’t covered by Medicare. Starting in 2019, however, some Medicare Advantage plans will cover certain types of home-based care, but that coverage will be partial and limited.
 
Medicare will temporarily cover skilled nursing care in a facility if it follows a three-day stay in a hospital as a result of a specific medical condition.3 For example, if you’re hospitalized for a stroke or a joint replacement, you may need to stay in a facility to recover. That type of care may be covered.
 
Depending on the length of the skilled nursing care, you’ll likely share the cost with Medicare. During the first 20 days of care, Medicare will cover all costs. Over the next 80 days, though, you’ll likely have a daily copay. After the 100th day of skilled nursing, you must pay for all costs with no coverage from Medicare.3
 
As you can see, Medicare is unlikely to meet all of your long-term care needs. You may want to explore alternative funding strategies, such as a long-term care insurance policy. Contact us today at Rex Financial Group for more information. We can help you analyze your needs and budget, and then implement a plan.
 
1https://assets.aarp.org/rgcenter/health/fs149_medicare.pdf
2https://longtermcare.acl.gov/the-basics/how-much-care-will-you-need.html
3https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care
 
Licensed Insurance Professional. This information is designed to provide a general overview with regard to the subject matter covered and is not state specific. The authors, publisher and host are not providing legal, accounting or specific advice for your situation. By providing your information, you give consent to be contacted about the possible sale of an insurance or annuity product. This information has been provided by a Licensed Insurance Professional and does not necessarily represent the views of the presenting insurance professional. The statements and opinions expressed are those of the author and are subject to change at any time. All information is believed to be from reliable sources; however, presenting insurance professional makes no representation as to its completeness or accuracy. This material has been prepared for informational and educational purposes only. It is not intended to provide, and should not be relied upon for, accounting, legal, tax or investment advice. This information has been provided by a Licensed Insurance Professional and is not sponsored or endorsed by the Social Security Administration or any government agency.
18148 - 2018/10/17

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