Medicare Long Term Care Coverage
August 6, 2019
Reviewed and Updated by Troy Frink,
More than half of adults aged 65 and older will need long-term support and services in their lifetimes according to the American Association of Retired Persons (AARP).
As you age, it can become difficult to perform everyday tasks such as bathing or getting dressed, and you may need assistance to do those things.
Long term care may consist of skilled nursing services or physical therapy immediately following an illness or injury, or it may consist of someone coming to your house to help you with day-to-day tasks.
Does Medicare Cover Long Term Care?
Original Medicare does not cover long term care unless it follows a hospital stay or is for necessary medical treatment.
However, you can use certain Medicare Advantage (Part C) or Medigap (Medicare Supplement) insurance plans to help pay for non-medically necessary long term care. Here’s what Original Medicare will cover:
Medicare Skilled Nursing Coverage
Medicare Part A will cover short stays (100 days or less) in skilled nursing facilities if you meet these qualifications:
- You’ve been admitted to the hospital for at least three days
- A Medicare-certified skilled nursing facility admits you within 30 days of the initial hospital stay
- Your treatment plan involves skilled care such as physical therapy or skilled nursing services.
Medicare will cover 100 percent of the costs for the first 20 days. In 2019, your copay for days 21-100 is $170.50.
For Medical Treatment
In order for Medicare to cover long term care for medical treatment, your doctor must first deem it medically necessary. Medicare Part B will cover the following services:
- Intermittent and part-time skilled nursing care
- Physical therapy
- Occupational Therapy
- Speech pathology
Your durable medical equipment (DME) can be covered if your doctor prescribes it and it will be used for at least three years. Medicare Part B also covers mental health services to help manage the psychological and cultural issues that come with having an illness.
There is no limit on how long you can receive the above services if your doctor reorders them every 60 days.
For Chronic Illnesses
Chronic Special Needs Plans (C-SNP) will cover long term care services for people with chronic illnesses. The covered services for conditions such as Parkinson’s and ALS are to help prevent and slow the progression of the symptoms.
Original Medicare will NOT cover prescription drugs for chronic illnesses, however. Prescription coverage falls under Medicare Part D and certain Part C plans.
Medicare Hospice Coverage
If you have a terminal illness with no chance of improvement, are expected to live less than six months, and are looking for peace instead of a cure, Medicare will cover hospice care.
In order for Medicare to cover drugs to control the symptoms and to relieve pain, you must be receiving care from a Medicare-approved hospice provider.
You can receive hospice care at your home, in a nursing home, or in a hospice care facility. When you enter hospice care, you will have an entire team of people focused on your overall comfort and well-being including your spiritual and emotional needs, not just your physical needs.
Long Term Care Coverage With Medicare Supplement Vs. Medicare Advantage
Private insurance companies offer plans that can go beyond what Medicare Parts A and B will cover. For non-medically necessary long term care, you won’t be able to use Original Medicare, and, for the most part, you won’t be able to use Medicare Supplements, either. If you want long term care coverage, a Medicare Advantage plan may be your best option.
Long Term Care Medicare Supplement
Medicare Supplements (Medigap) plans are designed to fill in the financial gaps Original Medicare creates. For example, you are financially responsible for that $170.50 copay. You can use a Medicare Supplement to help make those payments easier.
Medicare Advantage
Medicare Advantage (MA) plans are insurance plans that can cover medical services Original Medicare does not. While Medigap plans are strictly for help paying for out-of-pocket costs, MA plans are for additional medical coverage. Certain Part C plans can include coverage for DME and non-medical long term care, so it’s critical you know what your options are.
Note: You cannot have both a Medicare Supplement and a Medicare Advantage plan, so having someone help you sift through the thousands of plans out there and find the right one for you is extremely important to your overall health and well-being.
Why It’s Important to Have a Plan
Long term care can easily cost hundreds or thousands of dollars a month, and those costs will only increase. By 2050 the baby boomer population in the US will be 80 million, and that means more competition for home health care and therefore steeper prices. Having a health insurance plan to help with those costs might not only help you stay in good health, but also give you peace of mind.
Get Medicare Long Term Care Coverage Today
Are you looking for Medicare long term care coverage? One of our licensed agents can answer your questions and help you find the right plan for you. Fill out this form or call us at 844-431-1832 for a no-obligation appointment today.
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