Help! I Thought Medicare Covered Long-Term Care!

Dear Toni,

Recently in your Medicare column, you discussed services that are not covered by Original Medicare such as dental, vision, long-term care, and other items. I thought Medicare covered long-term care but was wrong, because my mother suffered a severe stroke, and her rehab facility notified me that Medicare is not paying for my mother’s care. Beginning next week, for her to receive care from this facility, it will have to be private pay, or she will have to go home. 

I need help understanding this confusing Medicare system. What is the difference between rehab/skilled nursing care and long-term care? I thought they were both the same!!

Thanks for your help,
Sue from Little Rock, Arkansas

Hi Sue,

Trying to understand the rules of Medicare when a loved one has a severe illness and requires both medical and custodial care is very frustrating. People are living longer today and want to control the quality of care, especially as their health needs begin to change. I’ll try to explain what long-term care is in simple terms.

The Basics of Long-Term Care

Page 56 of the 2024 Medicare & You handbook discusses how important it is to plan now to maintain your independence and receive the proper care in the setting you desire. Medicare only pays for medically necessary skilled nursing facility care or home health care, if you meet certain conditions. For example:

• Skilled nursing has 100 days of benefit. Days 1-20 have a $0 copay per day and days 21-100 have a specified copay per day.
• If you cannot qualify or do not meet Medicare’s qualification for skilled nursing, you will pay 100% of the cost out of your pocket. This is when a long-term care policy becomes essential.

Long-term care includes medical and non-medical care for those who have a chronic illness or disability. They may need help with activities of daily living such as bathing, dressing, eating, transferring, continence, ability to use the bathroom, or have cognitive impairment.

At least 70% of people over 65 will need long-term care services at some point. Long-term care can be provided at home, in an assisted living facility, personal care home, or nursing home.

Long-term care can be very costly. The average cost ranges from $54,000 a year for a 1 bedroom assisted living facility to $94,900 for an average nursing home. Original Medicare does not pay for these services.

Ways to Pay for Long-Term Care

1. Purchase a long-term care policy.

The younger you are when you purchase a long-term care policy, the lower the premiums will be. Many wait too long and qualifying is not easy because of health issues that keep one from meeting the underwriting requirements. Begin searching for a plan while you are younger and in good health. 

2. Purchase a life insurance policy with a long-term care provision.

Many life policies have such a provision so that you can receive a certain amount of your life policy’s face amount. 

3. Research what your qualifications are for your specific state’s Medicaid.

Verify what must be “spent down” to qualify. 

4. Aid and Attendance benefits with the VA can help veterans and spouses with long-term care issues.

Make sure to contact your local VA if you have any questions!

5. Dedicate personal resources such as savings, IRA, and 401K to help pay for long-term care needs.

Budgeting and saving your money now can help you later on down the road!

More Help with Medicare

If you need additional help understanding Medicare, then check out Toni King’s podcast, Medicare Moments.

Click here to download a free copy of the Medicare Prescription Drug Survival Guide.

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