Medicare Long Term Care Coverage

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?

Medicare Long Term Care Coverage | Medicare Plan Finder
Medicare Long Term Care Coverage | Medicare Plan Finder

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.

Medicare Durable Medical Equipment
Medicare Durable Medical Equipment

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.

Part D Checklist | Medicare Plan Finder
Part D Checklist | Medicare Plan Finder

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.

Medicare Advantage | Medicare Plan Finder
Medicare Advantage | Medicare Plan Finder

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.

Find Medicare Plans | Medicare Plan Finder
Find Medicare Plans | Medicare Plan Finder


Does Medicare Pay for Home Health Care?

Home health care is usually equally as effective as the care you would receive in a hospital or facility. If you have an injury or illness that prevents you from leaving your house, you’ll want to consider home health care.

Home health care coverage refers to not only in-home doctor visits and nurses, but also support for your family members who are taking care of you.

Medicare can cover the costs of your home nurse or doctor and can reimburse for caregiver services. However, if your relative is caring for you for the sake of saving money, it may be a good idea to take a look at what kind of coverage you might have for in-home doctors and nurses.

So, what does Medicare pay for home health care? The Original Medicare program covers hospital services under Part A, and it covers medical insurance needs such as doctor visits and limited home health care services under Part B

Medicare Part C, or Medicare Advantage (MA) health insurance plans are from private insurers and can offer “extra” home healthcare benefits. 

Medicare Home Care Benefits

Does Medicare Pay for Home Health Care? | Medicare Plan Finder
Does Medicare Pay for Home Health Care? | Medicare Plan Finder

Over the past few years, home health care services have greatly expanded. More and more seniors prefer to receive the care they need at home instead of in a nursing home or other facility.

However, nursing homes and long-term care facilities can be more expensive than home health care, because home care eliminates the need for room and board.

Kaiser Health News reports that over six million American seniors require home care. That means that they need help with dressing, bathing, eating, and other daily activities. However, a basic Medicare plan may not provide enough coverage for home care.

Having a nurse or aide in your home can cost well over $40,000 per year. With long-term care insurance, you’ll pay a premium instead, and your yearly costs will total at just over $2,000.

You’ll need to determine how much coverage you need ($50 per day, $100 per day, etc.) and what you’ll be using it for. You can use a long-term care policy for anything from a full-time nurse to home modifications, like ramp installations.

What Medicare Covers

Medicare does pay for some home care services if leaving your house is a tremendously difficult process and you need assistance.

Parts A or B (Original Medicare) covers skilled nursing services on an inconsistent basis – at least one time every two months, but only up to once a day, and only for three weeks at a time.

“Skilled care” means that it has to be performed by a qualified health care professional, or at least under his or her supervision.

Medicare Parts A and/or B will also cover physical therapy for recovery from injuries or illnesses, occupational therapy to help you learn how to perform day-to-day tasks with or without tools, and social services for medical needs.  

While Original Medicare will cover basic home care, additional services such as housekeeping and meal delivery fall under specific Medicare Advantage (Part C) plans.

Does Medicare Pay for Home Health Care by a Family Member?

Original Medicare will only cover services provided by a skilled healthcare professional. However, some state Medicaid programs will pay family members as caregivers.

How to Find Affordable Home Health Care

Learning about Medicare Home Care Benefits | Medicare Plan Finder
Searching for Affordable Home Health Care | Medicare Plan Finder

Your doctor will probably recommend a home health care service to you if he doesn’t provide those services himself. Otherwise, Medicare has a Home Health Agency finder so you can locate the care you need in your area. When choosing an agency for yourself or for a loved one, make sure you’re asking the right questions, such as:

  1. Are you Medicare (or Medicaid) certified?
  2. Do you offer ____ service?
  3. What are your hours and do they align with my needs?
  4. Will you have emergency staff available on weekends and after hours?
  5. Do you perform background checks on staff? Do you have credentials?
  6. Will I have to pay anything out of pocket?

Once you’ve narrowed your choices down, you may want to inquire about an agency’s quality of care. Any home care agency who services Medicare clients and has serviced at least 20 patients will have a star rating.

Patient Care Star Ratings are based on patient health improvement and the outcome of home treatments and care.

How to Use Medicare’s Home Health Agency Finder

Click here to go to the Medicare Home Health Agency finder. Enter your zip code to search for home health agencies in your area and click “search.” We used 37209, which is the zip code for our corporate offices in Nashville, Tennessee.

Medicare Home Health Agency Finder Step 1 | Medicare Plan Finder
Medicare Home Health Agency Finder Step 1 | Medicare Plan Finder

From there, you can filter search results by Medicare’s star rating and patient survey results. For demonstration purposes, we are only going to choose facilities with 5-star ratings.

Medicare Home Health Agency Finder Step 2 | Medicare Plan Finder
Medicare Home Health Agency Finder Step 2 | Medicare Plan Finder

Once the agency finder returns your search results, click on the agencies you want to compare. In our case, the finder returned two results. In this instance, both Deaconess Homecare and Homecare Solutions are part of LHC Group Health Care, which has locations in 38 states. The agency’s proximity to your home may be a determining factor in your choice for home care.

 Medicare Home Health Agency Finder Step 3 | Medicare Plan Finder
Medicare Home Health Agency Finder Step 3 | Medicare Plan Finder

Then click “compare now.”

Medicare Home Health Agency Finder Step 4 | Medicare Plan Finder
Medicare Home Health Agency Finder Step 4 | Medicare Plan Finder

Then the agency finder will show you comparison charts with general information, quality of patient care, and patient survey results. Use the comparison charts to help you make a decision about which home health agencies you want to contact.

Medicare Home Health Agency Finder Step 5 | Medicare Plan Finder
Medicare Home Health Agency Finder Step 5 | Medicare Plan Finder
Medicare Home Health Agency Finder Step 6 | Medicare Plan Finder
Medicare Home Health Agency Finder Step 6 | Medicare Plan Finder
Medicare Home Health Agency Finder Step 7 | Medicare Plan Finder
Medicare Home Health Agency Finder Step 7 | Medicare Plan Finder

How Do I Qualify for Home Benefits?

To qualify for home benefits, a doctor will need to certify that you have a medical need. For example, your policy will not pay for your stair lift if you still can walk up the stairs on your own without too much difficulty.

As another example, if you only need a nurse to help you with something occasional, like blood transfusions, your policy will not pay for you to have a full-time live-in nurse.

Your doctor will have to meet you in person to determine that you are homebound and need skilled nursing care. After your initial certification, your doctor must recertify your home health care plan once every two months. A Medicare-certified home health agency (HHA) must provide the care.

When You Should Buy

Like other health insurance policies, you should buy a long-term care policy before you need it. Pre-existing conditions and your age can raise your premiums. If you buy while you’re still healthy, you’ll likely have lower costs. However, if you can’t afford the premium now, while you’re healthy, then it may be best to wait.

One of our licensed and experienced agents can help you figure out if a long-term policy is something you should buy now or wait for. If you think it’s time to buy now, we’ll help you find a great plan in your area.

To set up an appointment, call 844-431-1832 or contact us here.

This post was originally published on December 07, 2017, by Anastasia Iliou, and was updated on August 07, 2019, by Troy Frink.

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