Medicare and Long Term Care

As we age and medical advances extend our lives, the odds of having a medical need increase every year. In particular, women are at higher risk as they live longer. Many clients ask about Medicare and Long Term Care and whether or not it is covered. In short, Medicare does not cover it.

Going into 2019, the average national cost of a nursing home room rose to the highest ever. A semi-private room in a nursing home long term care facility rose to over $89,000. And over $100,000 for a private room per year. It’s even higher here in Nevada. These numbers are staggering and unaffordable for the average American without good planning.

So, what kind of coverage can you expect from Medicare and how do you qualify for it?

Medicare states that it does not cover long term care, be it in your own house, in a nursing home or in assisted living. Although, it does cover short term stays in a skilled nursing facility. This can also include a nursing home.

The most common conditions where Medicare will have coverage is after a Medicare Beneficiary

  • Has been hospitalized (admitted) for a minimum of three days and released but has a continuing need for special care, as determined by their physician and approved by Medicare.

 

  • Goes to a Medicare-certified facility within 30 days of release.

 

  • Needs skilled care for rehabilitation.

Should the Medicare Beneficiary meet these conditions, Medicare will allow:

  • Up to 20 days of skilled (nursing) care at no cost.

 

  • Cover days 21 through 100 with a copay of $170.50 per day.

Beyond day 100, the Medicare Beneficiary is on their own as there is no more coverage from Medicare. Although, there is some additional coverage with Medicare Supplement plans or if the beneficiary has a certain Medicare Advantage Plan.

Summary: Under the right set of circumstances, you may be able to rely upon Medicare to be there for you on a short-term basis. But it will not do much for you in the long-term.

Let us know if you’d like more information. As your health insurance broker, we can provide you with face to face consultation. We also do not charge any fees for our services.