Why Doesn’t Medicare Pay for Long-Term Care?
Recently in your Medicare column, you discussed home healthcare for the elderly. I would like to know about Long-Term Care. I always thought Medicare covered long-term care, but now I am finding out I was totally wrong.
My mother has suffered a severe stroke. Her rehab facility is saying Medicare is not paying for her care. I’ve been informed that beginning next week, either to receive care from this facility, it will have to be private pay, or I will have to take her home. I need some help trying to understand this frustrating government system. What is the difference in rehab/skilled care and long-term care? I thought they were both the same!
Sue from Dallas, TX
Hi there Sue,
It is very frustrating to understand the rules of Medicare when a loved one has a severe illness and requires both medical and custodial care. I will try and explain what long-term care is, in as simple terms as I can.
People are living longer today and want to control the quality of care, especially when they may need some extra help when their health begins to change.
Medicare only pays for medically-necessary skilled nursing facility care or home health care, if you meet certain conditions. Skilled nursing has 100 days of benefit, with days 1-20 having $0 co-pays per day. If you cannot qualify or do not meet Medicare’s qualifications for skilled nursing, you will pay 100% of the cost out of your pocket. This is where Long-Term Care comes in!
Related: What is Long-Term Care?
Long-Term Care includes medical and non-medical care for people who have a chronic illness or disability. They may need help with activities of daily living, known as ADLs, such as bathing, dressing, eating, transferring, continence (ability to use the bathroom), or 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 adult day care, an assisted living facility, personal care home, or in a nursing home.
Long-term care can be very costly, when you begin to seek care. The average annual cost ranges from $40,000 per year for a 1 bedroom assisted living facility to $65,000 per year for an average nursing home.
1) Many 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 to try and qualify for their policy, and because of health issues, they may not meet the underwriting requirements. My advice is to look into Long-Term Care while you are younger and in relatively good health. Make sure that your policy covers care at home and also facility care.
2) Use your personal resources, such as savings, IRA, 401K etc. Many life policies have a provision if you need long-term care; you can receive a certain amount of your life policy’s face amount.
3) Check to see if you can qualify for Medicaid. Many have to “spend down” to qualify.
4) Aid and Attendance benefits with the VA can help Veterans with Long-Term Care issues. There are over $20 billion dollars available for long-term care pension money just waiting for Veterans to apply for their Aid and Attendance benefits. You need to have a Long-Term Care issue to qualify.
Toni Says: Long-term care can be very complex. Seek the advice of an Eldercare attorney who can help with long-term care issues and planning.
Originally published August 15, 2022