Medicare and Long-term Care: Exploring Your Options and Coverage
As people age, the need for long-term care becomes more and more likely. According to the U.S. Department of Health and Human Services, about 70% of people turning 65 can expect to use some form of long-term care during their lives. Long-term care can be expensive, and many people wonder how they will pay for it. Medicare is a federal health insurance program that can help cover some of the costs of long-term care, but there are some important things to know.
What is Long Term Care?
Long-term care is a range of services and supports you may need to meet your personal care needs. This type of care is often required when you have a chronic illness or disability or can’t perform some of your daily activities anymore. Long-term care can be provided at home, in the community, or in a nursing home facility. It may include:
Assistance with daily activities such as bathing, dressing, and eating
Skilled nursing care
Physical therapy
Rehabilitation
Palliative care
Long-Term Care And Medicare Coverage
Medicare and long-term care are two important and often intertwined topics for many individuals as they age. Long-term care refers to a wide range of services and support needed by individuals with chronic health conditions or disabilities. These services can include assistance with activities of daily living, such as bathing, dressing, and eating, as well as more specialized care, such as skilled nursing or rehabilitation.
Medicare, on the other hand, is a federal health insurance program that is available to individuals who are over the age of 65 or who have certain disabilities. Medicare provides coverage for various medical services, including hospital care, doctor visits, and diagnostic tests. However, it is important to note that Medicare does not cover long-term care services such as nursing home or in-home care. In other words, Medicare generally does not cover custodial care, which helps with daily activities like bathing, dressing, and eating.
Medicare Part A may cover up to 100 days of skilled nursing care after a hospitalization. However, certain conditions must be met, and there may be copayments.
Medicare Part B may cover some home health services, but only if they are medically necessary and ordered by a doctor.
Medicare does not cover long-term care in an assisted living facility.
This raises the question of how individuals can cover the costs of long-term care services if they are on Medicare. Original Medicare and Medigap plans do not cover full long-term care costs, but they do cover certain medical services received as part of long-term care. Original Medicare and Medigap can cover temporary stays in skilled nursing facilities, but the rules for coverage may vary depending on the type of surgery and length of hospital stay. Some Medigap plans can extend coverage for skilled nursing facility stays and reduce out-of-pocket costs for hospice services not covered by Medicare Part A.
If you are concerned about paying for long-term care, there are some other options you may want to consider.
What Are My Options for Getting Long-Term Care?
One option is to purchase a long-term care insurance policy. These policies are designed to cover the costs of long-term care services, and they can be a good option for individuals who are concerned about the potential costs of long-term care. However, long-term care insurance policies can be expensive and are not always a feasible option for everyone.
Some long-term care insurance policies may cover:
In-home care
Assisted Living
Adult daycare
Hospice care
Nursing home care
Long-term care insurance policies also may have limitations and exclusions, so it’s important to carefully review the policy before purchasing it.
Your second option is Medicaid, a joint federal and state program that provides health coverage for individuals with low income and assets. Medicaid can be used to pay for long-term care services. Still, it has strict eligibility criteria and requires individuals to spend most of their assets before they qualify for the program.
To be eligible for Medicaid, you must meet income and asset requirements. Each state has its rules for Medicaid eligibility, but you must generally have limited income and assets to qualify for Medicaid.
If you are eligible for Medicaid, it may cover the following:
Nursing home care
In-home care
Assisted Living
It’s important to note that Medicaid may not cover all long-term care costs, and there may be restrictions on the types of services covered.
The third option is that you can get long-term care through your Veteran benefits if you receive them. If you or your spouse is a veteran, you may be eligible for long-term care benefits through the Department of Veterans Affairs (VA). The VA offers a variety of long-term care services, including:
In-home care
Community-based care
Assisted Living
Nursing home care
To be eligible for VA long-term care benefits, you must meet certain eligibility requirements, including service-connected disabilities, income, and asset limitations.
Ultimately, your savings can be the most likable option for getting long-term care. It is important to plan and save for potential long-term care costs. Long-term care can be expensive, and it’s essential to have the plan to ensure you can afford the care you need.
Planning is vital when it comes to long-term care. Here are some things to keep in mind:
Start planning early. It’s never too early to start thinking about long-term care. The earlier you start planning, the more options you will have.
Consider your options. Various options are available for long-term care, including home-based care, assisted living, and nursing home care. Consider which option is best for you and your family.
Review your insurance coverage. Review your insurance coverage, including Medicare, long-term care insurance, and any other policies you may have. Make sure you understand what is and isn’t covered.
Work with a financial planner. A financial planner can help you develop a plan for paying for long-term care. They can also help you understand the tax implications of different options.
Communicate with your family. Make sure your family is aware of your long-term care plans. Discuss your wishes and make sure everyone is on the same page.
In conclusion, long-term care is a reality for many people as they age and can be expensive. Medicare does not cover all long-term care costs, but other options are available, including long-term care insurance, Medicaid, veterans benefits, and personal savings. Planning is key in long-term care, and it’s important to understand your options and review your insurance coverage. By planning, you can ensure that you are prepared for the potential costs of long-term care and that you can receive the care you need when you need it.