Critter Corner: Does Medicare Really Not Care About Long-Term Care?
Dear Bebe,
I read in a couple of Mr. Farr’s blogs that Medicare doesn’t cover long-term care. I thought that it did cover some long-term care services. Can you clarify? Thanks!
Metta Caire
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Dear Metta,
Medicare pays for health care for people age 65 years and older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease. Medicare only covers medically necessary care and focuses on acute care, such as doctor visits, drugs, and hospital stays. Medicare also covers short-term care and rehabilitation, such as physical therapy to help you regain your function, after injuries such as a fall or a stroke.
Medicare does not pay one penny, ever, for long-term care (often called custodial care) —which involves help with activities of daily living such bathing, dressing, and using the bathroom; nor does Medicare pay for supervision needed by those suffering from dementia.
What causes many people confusion is that Medicare will help pay for a short-term stay in a skilled nursing facility, for hospice care, or for home health care, but if you meet the following conditions:
• You have had a recent prior hospital stay of at least three days (3 midnights);
• You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay;
• You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy.
If you meet all these conditions, Medicare will pay for some of your costs for up to 100 days (i.e., short-term care). For the first 20 days, Medicare pays 100% of your costs. For days 21 through 100, you pay your own expenses up to $140.00 per day, and Medicare pays any balance. Anything after 100 days is considered long-term care, and you pay 100% of costs for each day you stay in a skilled nursing facility after day 100.
In addition to skilled nursing facility services, Medicare pays for the following services for a limited time when your doctor says they are medically necessary to treat an illness or injury:
• Part-time or intermittent skilled nursing care: Physical therapy, occupational therapy, and speech-language pathology that your doctor orders , for a limited number of days;
• Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease;
• Medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, you pay 20% of the Medicare approved amount.
There is no limit on how long you can receive any of these services as long as they remain medically necessary and your doctor reorders them every 60 days.
Hospice care
Medicare covers hospice care if you have a terminal illness and are not expected to live more than six months, but you must first switch your Medicare into “hospice mode,” which means that Medicare will then not cover existing medications and procedures that are designed to improve your condition. You may receive hospice care in your home, in a nursing home (if that is where you live), or in a hospice care facility. Medicare also pays for some short-term hospital stays and inpatient care for caregiver respite.
You can learn more at Medicare.gov. Hope this is helpful!
Purrs and hugs,
Bebe