Many individuals assume that Medicare will cover all costs associated with long-term care, such as staying in a nursing home. Unfortunately, Medicare does not cover most of the costs associated with long-term care, including nursing homes, assisted living, or adult daycare. So, if you are planning for yourself, or for a relative, here is some important information you need to know.
What Does Medicare Cover?
Skilled Nursing Care
Medicare helps cover the costs related to recovering in a skilled nursing care facility following a three-day hospital stay. Medicare covers all costs for the first 20 days, some of the costs for the next 80 days, and stops paying after 100 days.
Home Health Care
skille will pay for nurses and therapists to come to your home if you are housebound by an injury or illness, and your doctor has determined that you require short-term skilled care. This does not include round the clock care, but is typically limited to a total of 28 hours per week. This can be adjusted upward if recommended by a doctor.
Medicare covers all hospice care. You are eligible for this coverage if your terminal illness is no longer being treated and the doctor certifies that you probably have less than six months to live.
Hospice care refers to treatment provided by nurses, doctors, social workers, volunteers, and various spiritual leaders to provide comfort and pain management for patients who are terminally ill.
Hospice is not tied to a specific place but can be offered at home, in an assisted living facility, in a nursing home, or in a hospice facility.
Eligibility for Medicare’s Hospice Benefits
Requirements to be eligible for Medicare’s hospice benefits include:
- The patient must be at least 65 years of age.
- The patient must be diagnosed with a terminal illness.
- The patient must have certification from a doctor stating that he or she has less than six months to live.
- The patient must agree to forgo any life-saving or potentially curative treatments.
- Medicare must approve the hospice provider.
Hospice Services Covered by Medicare’s Benefits
Medicare covers a wide range of hospice services, including:
- Bereavement services for families
- Counseling – dietary, pastoral, and other types
- Hospice aide and homemaker services
- Inpatient care
- Medical appliances and supplies (including drugs and biologicals)
- Medical social worker services
- Nursing care
- Physical and occupational therapies
- Physician services
- Speech-language pathology services
Alternative Financial Sources for Nursing Care
As Medicare does not cover nursing care, you will need to look at alternative sources, such as:
Personal Savings or Loan
Long-term nursing care can be very expensive. The easiest option would be to use your savings or to get a loan such as a reverse mortgage to cover the costs.
Long-Term Care Insurance
Many insurance companies sell long-term care insurance to cover costs not covered by Medicare such as long-term nursing care, assisted living, or extended home care. The younger you are when you buy the insurance the better your rates will be. Individuals who have worked for the government or were in the military may qualify for a discounted rate on their insurance.
If your income or assets are low enough you might qualify for Medicaid, which will then cover most of your long-term care costs. For those who have both Medicare and Medicaid, the majority of their health costs will be covered. The qualifications for Medicaid vary from state to state.
TRICARE is a health care program that provides health benefits for active military personnel, retirees, and their dependents. The U.S. Department of Defense sponsors this program.
CHAMPVA is an acronym for Civilian Health and Medical Program of the Department of Veterans Affairs. CHAMPVA is a health care program that provides health benefits for the beneficiaries of certain deceased or disabled veterans. The Veterans Administration sponsors it.