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Does Medicare Cover Long Term Care?

Unfortunately, there aren’t Medicare long-term care coverage benefits. There are, however, other options that could help you cover these costs, and Medicare may cover similar services for short stays.

What Is Long-Term Care?

Long-term care provides care to people who are living with chronic health conditions that prevent them from performing the activities of daily living along. There are six routine activities that determine if a person is capable of living alone. They include:

  • Eating
  • Bathing
  • Dressing
  • Toileting
  • Transferring (walking)
  • Continence (holding back bodily functions)

Does Medicare Cover Long-Term Care in a Hospital Setting?

No, Medicare won’t pay for long-term care in a hospital setting either. Medicare may pay for a limited number of days for post-acute care in a hospital.

You may qualify for post-acute care for the following reasons:

  • You’re not stable enough to leave the hospital for some reason.
  • You’re at risk of a severe complication.
  • You’re fighting an infection and need IV medications.
  • You’re waiting for medical care urgently.
  • Your doctor has not released you to other care.

Keep in mind that in addition to only having coverage for post-acute services for a limited number of days, Medicare usually only pays for up to 80% of the costs.

Is there Medicare Long-Term Care Coverage for Skilled Nursing Facilities?

Medicare has coverage for short stays in a skilled nursing facility if it’s necessary for post-acute care. You may qualify if:

  • You’ve been admitted to the hospital for at least three days.
  • You’re admitted to a Medicare-certified nursing facility within 30 days of being in a hospital inpatient.
  • You need skilled medical care. Examples of this include skilled nursing, physical therapy, specialized treatments, or other types of therapy.

You must meet all three of these conditions to qualify for coverage. Just as with post-acute care in a hospital setting, Medicare won’t pay 100% of your costs, and you have a limited amount of days that are covered.

Can I Get Long-Term Care Insurance?

Yes, long-term care insurance exists, and can help you cover these costs. Long-term care services are typically less expensive when you buy them at a younger age, and while you’re healthier. The older you are, the more costly they can become, so it’s wise to consider purchasing a policy at a younger age. Details of long-term care insurance can vary, so it’s important that you review your options carefully.

Do Medicare Supplement Plans Cover Long-Term Care?

Medicare Supplement plans are secondary to Medicare, so they only cover the costs that Medicare covers first. Because Medicare doesn’t cover long-term care, Medicare Supplement plans don’t cover it either. They can, however, help cover costs like coinsurance and deductibles for post-acute care.

Do Medicare Advantage Plans Cover Long-Term Care?

As of 2019, Medicare Advantage plans can offer benefits for some long-term care services. These benefits include transportation to doctor appointments and frozen meal delivery. If you have an Advantage plan, you should review your policy for details.

Paying for long-term care can be expensive out-of-pocket. Whether you have Medicare alone, a Medicare Supplement plan, or an Advantage plan, they most likely won’t offer enough protection for the costs of long-term care. To avoid paying out-of-pocket, you may want to consider a long-term care insurance policy. If you do, you should compare your options carefully to determine what level of protection is right for you.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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