Help With Long Term Care: Medicare or Medicaid?
There are many people who think that Medicare will help pay for the day when they or a loved one needs continuing nursing home or other long term care. Unfortunatly, that is not usualy the case. Medicare only covers costs for services that are medically necessary.In most cases, Medicare doesn’t pay for long-term care unless its for a medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care, and there are strong limitations. "Medically necessary" usually means the care someone needs temporarily --like after surgery, perhaps-- and NOT the "custodial care" which makes up most long term care. Custodial care (non-skilled care) is care that helps you with activities of daily living, like dressing, bathing, and using the bathroom.
Medicare doesn’t pay for this type of care called "custodial care".
It's possible that a Medicare Advantage Plan --above what Medicare itself pays-- could include limited skilled nursing facility and home care (skilled care) coverage if the care is medically necessary. Of course, it would depend on the particulairs of coverage that was purchased.
(For other Medicare topics, see our home page The Medicare Project - home)
We do not sell, endorse or recommend any product or service.
Our editors selected these web pages and brochures from government, education, and non-commercial sites as a cross section of information about these subjects.
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web page: What is Long-Term Care? source:Medicare.gov - The Official U.S. Government Site for People with Medicare languages: English topics from the web page: "Medicare and Long-Term Care; Medicaid and Long-Term Care; Choosing Long-Term Care..." web page: Long-Term Care source:Henry J. Kaiser Family Foundation languages: English from the web page: "...Be Aware of Medicare's Limits. While Medicare covers some home health, skilled nursing, and hospice care, it is not a long-term care program. For example, although Medicare covers relatively short-term, medically necessary home health care, it does not pay for custodial care services such as cleaning or cooking at home. Nor does the program pay for prolonged care in a nursing home...." |
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Medicare and Long-Term Care
source:Georgetown University Long-Term Care Financing Project
languages: English
from the brochure: "...Medicare pays for nursing home and home care services, but Medicare is designed to pay for the treatment of acute, short-term illness. These services are available only to beneficiaries who need skilled nursing care or therapies, and are often timelimited....."
more from Georgetown University Long-Term Care Financing Project:
brochure:
'MEDI-LTC' A New Medicare Long-Term Care Proposal
file size:23 pgs; languages: English
from the web page: "...This paper discusses an approach to creating a new Medicare “add-on” product, a voluntary, private, long-term care insurance program that is supplemental to Medicare. This approach is particularly well matched to current societal needs. The primary objective is to increase the number of Americans with long-term care insurance benefits...
web page:
Medicare - Skilled Nursing Facility Coverage
source:ElderLawAnswers
languages: English
from the web page: "Medicare Part A covers up to 100 days of "skilled nursing" care per spell of illness. However, the conditions for obtaining Medicare coverage of a nursing home stay are quite stringent. Here are the main requirements:..."
web page:
Medicare, Medicaid, and Long Term Care
source:The Motley Fool
languages: English
from the web page: "In last week's column, I discussed the definition of long term care and the problems many folks face in paying for such services when they are needed. We saw that such costs are covered in just four ways: by us out-of-pocket, by Medicare, by Medicaid, or by insurance. This week we'll see how Medicare and Medicaid handle long term care services...."
web page:
Nursing Home Quality Initiatives - Overview
source:Centers for Medicare & Medicaid Services
languages: English
from the web page: "...Many of these facilities are licensed only at the state level. In addition, some nursing homes that provide a full range of care, including skilled nursing services, choose not to participate in Medicare or Medicaid.... "
web page:
SKILLED NURSING FACILITY ("SNF") SERVICES
source:Center for Medicare Advocacy, Inc.
languages: English
from the web page: (topics include) "What does Medicare cover? When does Medicare cover skilled nursing facility care? Can a patient who is receiving non-skilled "custodial" services receive Medicare coverage in a SNF? What are examples of skilled services in a SNF? What is the prospective payment system in a skilled nursing facility?"
web site:
Medicare / Medicaid Nursing Homes & Long Term Care Directories - The Nursing Home Project
languages: English
from the web site: "Nursing Homes in the US and Long Term Care Facilities are listed by cities within each state and includes location, phone, Medicare/Medicaid information, and more." brochure:
Medicare Coverage of Nursing Home Care
source:Pro Seniors, Inc.
file size:5 pgs; languages: English, Spanish
from the brochure:"1. When does Medicare cover nursing facility care? Skilled nursing facility (SNF) care is covered if you were admitted to a nursing home within 30 calendar days after the date of discharge from a hospitalization of at least 3 consecutive days. Also, your doctor must order and you must receive either skilled nursing services on a daily basis or skilled rehabilitation services 5 or more days a week. Medicare does not cover custodial or intermediate care in a nursing facility....."
more from Pro Seniors, Inc.:
brochure:
Medicare Coverage of Nursing Homes: Identifying Wrongful Denials
file size: 4 pgs; languages: English
from the web page: "When is skilled nursing facility care covered by Medicare? Skilled nursing facility (SNF) care is covered if you, the resident, have been hospitalized at least 3 consecutive days within 30 days after you were admitted to a SNF. Your doctor must order and you must receive either skilled nursing services on a daily basis or skilled rehabilitation services 5 or more days a week. If you need care that does not require a skilled professional, Medicare will not cover your SNF stay..."
web page:
Consumer Booklet - Medicare Home Health Care
source:Medicare Rights Center
languages: English
from the web page: "Medicare will pay for home health care when the care is provided at home for homebound patients who need skilled nursing and/or skilled therapy. Whether the illness is acute, chronic or advanced, a home health agency can:..."
web page:
Fact Sheets - Home Health Care
source:Eldercare Locator - U.S. Administration on Aging
languages: English
from the web page: "Medicare is the largest single payer of home care services. The Medicare program will pay for home health care if all of the following conditions are met: * The patient must be homebound and under a doctor’s care; * The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously) * The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient * The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary” * The home health care agency providing the services must be certified by the Medicare program..."
web page:
Coverage Implications of Delaying the Age of Medicare Eligibility.
source: U.S. National Library of Medicine
languages: English
from the web page: "Rising costs are likely to generate renewed calls to delay the Medicare eligibility age to 67. A buy-in option to Medicare has been proposed to mitigate the impact of a restriction in eligibility. This paper examines the effects of an increase in the Medicare eligibility age, with and without a buy-in option, on insurance coverage and retirement decisions for Americans ages 65 and 66..."
Medicare - Skilled Nursing Facility Coverage
source:ElderLawAnswers
languages: English
from the web page: "Medicare Part A covers up to 100 days of "skilled nursing" care per spell of illness. However, the conditions for obtaining Medicare coverage of a nursing home stay are quite stringent. Here are the main requirements:..."
Medicare, Medicaid, and Long Term Care
source:The Motley Fool
languages: English
from the web page: "In last week's column, I discussed the definition of long term care and the problems many folks face in paying for such services when they are needed. We saw that such costs are covered in just four ways: by us out-of-pocket, by Medicare, by Medicaid, or by insurance. This week we'll see how Medicare and Medicaid handle long term care services...."
Nursing Home Quality Initiatives - Overview
source:Centers for Medicare & Medicaid Services
languages: English
from the web page: "...Many of these facilities are licensed only at the state level. In addition, some nursing homes that provide a full range of care, including skilled nursing services, choose not to participate in Medicare or Medicaid.... "
SKILLED NURSING FACILITY ("SNF") SERVICES
source:Center for Medicare Advocacy, Inc.
languages: English
from the web page: (topics include) "What does Medicare cover? When does Medicare cover skilled nursing facility care? Can a patient who is receiving non-skilled "custodial" services receive Medicare coverage in a SNF? What are examples of skilled services in a SNF? What is the prospective payment system in a skilled nursing facility?"
Medicare / Medicaid Nursing Homes & Long Term Care Directories - The Nursing Home Project
languages: English
from the web site: "Nursing Homes in the US and Long Term Care Facilities are listed by cities within each state and includes location, phone, Medicare/Medicaid information, and more." brochure:
Medicare Coverage of Nursing Home Care
source:Pro Seniors, Inc.
file size:5 pgs; languages: English, Spanish
from the brochure:"1. When does Medicare cover nursing facility care? Skilled nursing facility (SNF) care is covered if you were admitted to a nursing home within 30 calendar days after the date of discharge from a hospitalization of at least 3 consecutive days. Also, your doctor must order and you must receive either skilled nursing services on a daily basis or skilled rehabilitation services 5 or more days a week. Medicare does not cover custodial or intermediate care in a nursing facility....."
more from Pro Seniors, Inc.:
brochure:
Medicare Coverage of Nursing Homes: Identifying Wrongful Denials
file size: 4 pgs; languages: English
from the web page: "When is skilled nursing facility care covered by Medicare? Skilled nursing facility (SNF) care is covered if you, the resident, have been hospitalized at least 3 consecutive days within 30 days after you were admitted to a SNF. Your doctor must order and you must receive either skilled nursing services on a daily basis or skilled rehabilitation services 5 or more days a week. If you need care that does not require a skilled professional, Medicare will not cover your SNF stay..."
Consumer Booklet - Medicare Home Health Care
source:Medicare Rights Center
languages: English
from the web page: "Medicare will pay for home health care when the care is provided at home for homebound patients who need skilled nursing and/or skilled therapy. Whether the illness is acute, chronic or advanced, a home health agency can:..."
Fact Sheets - Home Health Care
source:Eldercare Locator - U.S. Administration on Aging
languages: English
from the web page: "Medicare is the largest single payer of home care services. The Medicare program will pay for home health care if all of the following conditions are met: * The patient must be homebound and under a doctor’s care; * The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously) * The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient * The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary” * The home health care agency providing the services must be certified by the Medicare program..."
Coverage Implications of Delaying the Age of Medicare Eligibility.
source: U.S. National Library of Medicine
languages: English
from the web page: "Rising costs are likely to generate renewed calls to delay the Medicare eligibility age to 67. A buy-in option to Medicare has been proposed to mitigate the impact of a restriction in eligibility. This paper examines the effects of an increase in the Medicare eligibility age, with and without a buy-in option, on insurance coverage and retirement decisions for Americans ages 65 and 66..."