Medicare

Medicare and Long Term Care

Medicare is the health insurance program for people over age 65 and the disabled who meet the eligibility requirements. Medicare does a great job in paying for hospital and doctor stays.  It is primarily designed to pay for acute care.  It’s purpose is to get you back on your feet and back home. The benefits for long term care are very limited.

–       Limited short term skilled care in the home

–       No Assisted Living care

–       No Adult Day care

–       Maximum 100 days in a nursing home

First, a physician must determine that you need acute restorative/rehabilitative care.  You can only receive this rehabilitative care in a Medicare certified facility.  Medicare covers skilled care only- not custodial care.  Over 95% of long term care is custodial care.

* While Medicare helps provide up to 100 days of skilled nursing facility care, it doesn’t cover custodial care for personal needs or care that doesn’t require professional medical skills or training.
* Admission to a skilled nursing facility must be within 30 days of a three-day hospital stay, and admission can only be for the condition that was treated during that hospital stay.
* A physician must certify the need for daily skilled care.

To find out more about how Medicare pays for long term care, visit www.medicare.gov.

 

Medicare Supplemental Insurance and Long Term Care

Medicare supplemental insurance is also called MedSup or Medigap. These policies cover some or all of Medicare’s deductible, co-payments, and coinsurance.  Their primary purpose is to supplement the coverage you have through Medicare.  It follows the Medicare guidelines and does not pay for custodial care. It is not a long term care policy.

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