Long term care generally refers to personal and medical services for people with chronic illnesses, disabilities, or limitations in their ability to function independently. It’s important for seniors and their loved ones to know that Medicare only covers medically necessary care in certain circumstances, and for a limited time.
Medicare does not cover long-term custodial care—that is, help with everyday tasks and activities, such as bathing, dressing, toileting, shopping, and housekeeping. Nursing home care is not covered when the only care a person needs is help with daily activities (custodial care), nor is custodial care in an assisted living community.
Medicare does cover the following:
- Skilled nursing care in a nursing facility: Medicare Part A covers care in a skilled nursing facility (SNF) for a limited time under certain conditions. Medicare-covered services include semi-private rooms, skilled nursing care, medications, medical supplies and equipment, meals, and other services in a skilled nursing facility. The medicare.gov page on skilled nursing facility care has more information about costs and benefit periods.
- Care in a long-term care hospital (LTCH): Medicare Part A (hospital insurance) covers patients receiving treatment for one or more serious conditions, but who may improve with time and return to their homes. Patients will not pay more for care in an LTCH than they would in an acute care hospital. Under Medicare, you’re only responsible for one deductible for any benefit period. The medicare.gov page on long-term care hospitals has more about costs.
- Hospice care: Hospice care is typically provided in the home after a terminally ill person decides they no longer wish to cure their terminal illness, or after the patient and doctor have determined that efforts to cure the illness aren’t working. The services covered by Medicare while a person is in hospice care may include doctor services, nursing care, medical equipment and supplies, drugs for pain relief, grief and loss counseling for the patient and family members, and other services. Generally, hospice care does not cost anything; however, there may be copayments for prescription drugs and pain relief drugs. Learn more about hospice coverage on the medicare.gov hospice and respite care page.
- Limited home health services: Eligible home health services covered by Medicare include intermittent skilled nursing care, speech-language pathology services, physical therapy, and others. Medicare will not pay for custodial care—round the clock care at home to help with the activities of daily living and personal care. There is generally no cost for covered home health care services, however, Medicare recipients must pay 20% of the Medicare-approved amount for durable medical equipment (such as walkers, wheelchairs, and hospital beds). Read the home health care page on medicare.gov for more information.
Our next post will cover long-term care insurance policies, their advantages and disadvantages, and things to consider before purchasing such a policy. For more information about what Medicare covers and for assistance with Medicare enrollment, call the experts at CA Medicare today.