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Medicare and Long Term Care

What Medicare Does and Does NOT Pay For

Medicare and long term care.

Most people think of Medicare as the health plan for people over 65—assuming it’s a reliable safety net that will cover most, if not all, medical expenses. The truth is that there is a large, gaping hole in Medicare coverage - long term care.

FACT: Medicare does not pay for long term care.

Long-term care is becoming more and more critical. According to the Family Caregiver Alliance the number of people who will need long-term care is projected to grow from 13 million - according to 2000 statistics - to 27 million by 2050, as the Baby Boomer population ages.

This care is often expensive—and for many, paying for it is a challenge. Yet, if you are age 65 or older, the probability that you will need long term care at some point in the future is around 68%.

Long-term care may refer to medical services, but it also refers to non-medical assistance with what’s called “activities of daily living” (ADL's) such as bathing, eating, cooking, dressing, using the restroom, and other basic necessities.

Long-term care could be as intensive as round-the-clock nursing care or as light as occasional errand-running and housekeeping help. You could receive long-term care at home, in a nursing home, or at an assisted living facility.

The definition for long term care is important because Medicare only pays for short-term recovery, from specific illnesses or injuries, where you are expected to get better.

If you need to spend a limited amount of time in a skilled nursing care facility to recover from a heart attack, for example, or a major injury, that’s generally covered by Medicare in full up to 20 days, and partially from day 21 to day 100.

Medicare will pay for home health care on a short-term basis. It will pay for nurses, therapists, and other healthcare professionals to provide at-home care for up to approximately 35 hours per week, depending on your doctor’s recommendation. Hospice care is also covered—this is care for people in the last stages of a terminal illness.

Medicare may also pay for part-time or periodic skilled nursing care, physical or occupational therapy, and medical social services on an ongoing basis, depending on your doctor’s recommendation. But if you are not terminally ill and need indefinite long-term care, it is not covered by Medicare.

Many people rely on their own savings to pay for their care—taking out reverse mortgages and spending down retirement accounts and savings they had hoped to leave to their families. Some people “spend down,” or spend all the savings they have accumulated in order to qualify for Medicaid, which does provide long-term care coverage for those at the lowest end of the poverty spectrum.

Long Term Care Insurance

The better option, however, is to buy long-term care insurance.The earlier you buy the policy, the less expensive it will be. Some companies will allow you to swap your life insurance policy for a long-term care policy, and you may qualify for a discount if you served in the military or worked for the government.

When paying for long-term care, it’s essential to plan ahead. Talk to an insurance professional about getting long-term care insurance, and you or your loved one won’t be required to decimate savings it took years to build in order to pay for care at the end of life.

Additional Medicare Resources:

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