Not only is long-term care expensive, it's also a growing concern (thanks to ever-expanding lifespans). Will Medicare help?
Long-term care describes a range of services and support an aging person needs for daily living. We know you have questions about Medicare and long-term care. As we dive into that topic, let’s discuss the different types of long-term care. We will also give you long-term care options and ideas on paying for those services.
Skilled care vs. custodial care
Before we discuss long-term care options and Medicare, you must understand the two major types: skilled care and custodial care.
Licensed healthcare professionals, such as nurses and physical therapists, provide skilled care. A doctor orders these services, which may include physical therapy, wound care, injections, catheter care, and other healthcare services.
On the other hand, nurses’ aides or non-licensed workers provide custodial long-term care. These individuals can help with a person’s daily activities, such as cooking, bathing, dressing, and completing errands.
Please note: you can receive skilled care or custodial care at home or in a facility, such as a nursing home.
Medicare and long-term care
Medicare and most health insurance policies do not pay for long-term custodial care. Instead, people use their personal savings, pensions, income from stocks, or long-term care insurance to pay for these services.
Medicare Part A (hospital insurance) may cover skilled nursing facility (SNF) care for a limited time if you have a qualifying inpatient hospital stay. Your doctor will decide if you need care from, or under the supervision of, skilled nursing or therapy staff. Here’s how the coverage works in a skilled nursing facility:
- Days 1 - 20: $0 coinsurance
- Days 21 - 100: $200 coinsurance per day
- Days 101 and beyond: You pay all costs
Please note that you must have a qualifying hospital stay before Medicare will cover SNF services. This means you must have spent a full 72 hours as an inpatient, i.e., were formally admitted to the hospital.
Medicare Part B helps cover the cost of healthcare provider services, usually around 80%. It does not pay for SNF or home health care services.
What about Medicare Advantage or Medigap?
Medicare Part C, more commonly known as Medicare Advantage, bundles your Parts A and B benefits into a single health insurance policy that resembles the group health plans you likely had through an employer.
The Centers for Medicare & Medicaid Services (CMS) requires all Medicare Advantage plans to cover everything Original Medicare does. They are not limited to those benefits though, and most (99%) offer additional goodies, like prescription medications and routine vision and dental. Although long-term care is a rare benefit with any type of health insurance, you should check with your plan to be sure.
Medicare Supplement Insurance, more commonly known as Medigap, covers some or most of your out-of-pocket costs when you have Original Medicare. What's covered depends on which plan you choose, but every Medigap plan at least covers your Part A coinsurance.
Of course, Medigap plans only help pay for items that are covered by Original Medicare, which means you can't use them to pay for non-covered services – like long-term care.
It's easy to compare the costs and benefits of Medicare plans with our Find a Plan tool. The only information required is your zip code.
Who to go to for help
Again, Medicare does not pay for long-term custodial care – or help with the activities of daily living. Because of that, figuring out long-term care can be stressful.
Besides talking with your family members, you can also discuss your needs with a healthcare provider, social worker, or counselor. If you are currently in a hospital, you can discuss your options with a discharge planner or hospital social worker.
Finally, reach out to the following organizations to learn about available resources in your area:
- Aging and Disability Resource Center (ADRC)
- Area Agency on Aging (AAA)
- Center for Independent Living (CIL)
Long-term custodial care options
Here are some long-term care options for those who do not need a skilled nursing facility. Your economic resources may determine what type of care you can receive.
Home and custodial care services
Home health agencies offer home and custodial care services that can be purchased without a physician’s order. Workers from these agencies can help with meal preparation and household chores. They can also help with bathing and dressing. Medicare does not pay for these services.
Fall detectors and medical alert systems are great options for those planning to age in place. Some families utilize in-home camera systems to monitor those who need some supervision.
Other community resources
Discuss your needs with area aging agencies and senior centers. Community resources may include the following:
- Transportation services
- Meal programs
- Legal assistance
Some homes have a second living space with a kitchen and bathroom. Sometimes called “in-law apartments” or “second units,” these spaces may be added to a single-family home – as long as the addition isn’t against local zoning laws.
Subsidized senior housing
State and federal programs (other than Medicare) help pay for housing for low-income seniors. The rent payments for subsidized apartments are usually based on a percentage of your income.
Continuing care retirement communities
Continuing care retirement communities offer different kinds of housing – and levels of care. For example, there may be individual homes or apartments, an assisted living facility, and a skilled care nursing home in the same community.
The benefit of continuing-care retirement communities is that residents can move from one level to another based on their needs.
Program of All-Inclusive Care for the Elderly (PACE)
Medicare does not pay for long-term care. However, PACE is a Medicaid program that helps people meet their care needs. PACE is only available in some states’ Medicaid programs. You must be the following qualifications to receive PACE services:
- At least 55 years old
- Live in a PACE service area
- Need a nursing home-level of care
- Can live safely in the community with help from PACE
PACE offers the same coverage as Medicare and Medicaid for those who qualify, including prescription drugs. PACE may also cover adult day care, dentistry, meals, social work counseling, and transportation to the PACE center for activities or medical appointments.
If you qualify for Medicaid, you won’t pay a monthly premium for the long-term care portion of PACE. If you don’t qualify for Medicaid but have Medicare, you’ll pay a monthly premium to cover the long-term care portion of PACE and a monthly premium for Medicare Part D (Prescription Drugs). There’s no deductible or copayment for any care or service approved by your healthcare team.
You can pay for PACE yourself if you don’t have Medicare or Medicaid. To determine eligibility, search for PACE plans in your area or call your Medicaid office.
Long-term care planning
It can be challenging to plan for the future. However, planning for long-term care before you need it is best. Unfortunately, unexpected illnesses or accidents can change your situation and force you to make decisions quickly.
You might be able to delay or prevent the need for long-term care by staying healthy and independent. Talk to your healthcare providers about your medical and family history and lifestyle, and take action now to improve your health. Also, learn how to create a safe home to prevent life-changing accidents.
Long-term planning will make you more comfortable with the idea of aging and reduce the stress on your immediate family members.