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Understanding Your Options for Medicare and Long-Term Care

Posted by Meredith Casillas
Estimated Reading Time 1 minute 44 seconds

Understanding Your Options for Medicare and Long-Term Care

As we enter our sixties, planning for long-term care becomes increasingly important. Understanding what Medicare covers—and what it doesn’t—can help you and your family make informed decisions about future healthcare needs. While Medicare provides substantial coverage for many health services, its support for long-term care is limited.

Medicare Coverage Basics

Medicare, a federal health insurance program for individuals 65 and older, has several parts.

  • Part A: Hospital Insurance. Covers inpatient hospital stays, care in a skilled nursing facility (SNF), hospice care, and some home health care.
  • Part B: Medical Insurance. Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
  • Part C: Part C: Medicare Advantage Plans. Offered by private companies, these plans provide all Part A and Part B coverage and may include a Prescription Drug plan.
  • Part D: Prescription Drug Coverage. Helps cover the cost of prescription drugs.

Long-Term Care Coverage Under Medicare

Medicare covers some aspects of long-term care but does impose some significant limitations.

  • Skilled Nursing Facility (SNF) Care: Medicare Part A covers up to 100 days in an SNF following a qualifying hospital stay of at least three days. The first 20 days are covered in full, but days 21-100 require a daily co-payment. After 100 days, Medicare provides no coverage.
  • Home Health Care: Medicare covers home health care if it is medically necessary and ordered by a doctor. This includes part-time or intermittent skilled nursing care, physical therapy, and other services, but not full-time long-term care or custodial care (help with daily activities like bathing and dressing).
  • Hospice Care: Medicare provides comprehensive hospice care coverage, including medical and support services, for individuals with terminal illnesses.

What Medicare Does Not Cover

Medicare does not cover long-term custodial care in a nursing home, assisted living facility, or home if that is the only necessary care. Custodial care involves assistance with activities of daily living (ADLs) such as bathing, dressing, and eating.

Exploring Additional Options

Given these limitations, it’s essential to consider other options for long-term care funding.

  • Medicaid: For those with limited income and assets, Medicaid can provide long-term care coverage. Eligibility and benefits vary by state.
  • Long-Term Care Insurance: Policies are available to cover long-term care services, including custodial care specifically.
  • Personal Savings and Assets: Some individuals may need to rely on personal savings, investments, or the sale of assets to fund long-term care.

Understanding Medicare’s limitations regarding long-term care is crucial for effective planning. Contact us if you have any questions or if we can be of assistance.

Meredith Casillas
OKMedicareHelp.com // meredith@casillasinsurance.com

I moved to Tulsa from Philadelphia at the age of 10 and have been an Okie ever since. I graduated from Oral Roberts University with a Business Marketing degree but soon found myself following my husband around the country to pursue his baseball career. We always called Tulsa our home and eventually settled here permanently to raise our 3 kids.

While working for a local financial advisor I discovered my passion is to build relationships with clients and in turn empower them to make informed decisions for themselves. I chose to move to health and life insurance sales under Legacy Insurance Advisors because of their commitment to educating and supporting their agents, which as a result makes me a better resource for my clients.

Decisions made about Medicare or Life insurance, if done right, can provide financial security and independence for your future. I would be honored to help you understand your choices.

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