Can I get long-term care services with Medicare?
Does Medicare cover long-term care or nursing home services?
Medicare generally does not cover long-term care or custodial care (which includes assistance with daily activities like bathing, dressing, and eating) in a nursing home or other long-term care facility. However, Medicare may cover short-term skilled nursing care and certain medical services in specific situations.
Here’s a breakdown of what Medicare covers and does not cover for long-term care and nursing home services:
1. Medicare Part A Coverage for Skilled Nursing Facility (SNF) Care:
Medicare Part A covers short-term skilled nursing facility (SNF) care under certain conditions, but it does not cover long-term custodial care. Medicare will cover SNF care if:
You had a qualifying hospital stay: To qualify, you must have been admitted as an inpatient in a hospital for at least 3 consecutive days (not counting the day of discharge).
You need skilled care: The care you receive must be medically necessary and provided by a skilled nurse, therapist, or other qualified healthcare provider. Examples include physical therapy, wound care, or intravenous injections.
You are admitted to a Medicare-certified skilled nursing facility: You must receive care in a facility that is certified by Medicare.
What Medicare Covers in a Skilled Nursing Facility:
Semi-private room (shared room).
Meals.
Skilled nursing care.
Physical, occupational, and speech therapy.
Medical social services.
Medications, medical supplies, and equipment used during your stay.
Ambulance transportation (if medically necessary).
Duration of Coverage:
Full coverage for the first 20 days: Medicare covers the full cost of skilled nursing care for the first 20 days of your stay.
Days 21-100: You are responsible for a daily coinsurance amount, which is $204 per day in 2024, while Medicare covers the rest.
After 100 days: You are responsible for the full cost of care if your stay extends beyond 100 days.
2. What Medicare Does Not Cover:
Medicare does not cover:
Long-term custodial care: This includes assistance with daily activities such as bathing, dressing, eating, and using the bathroom if it is the only care you need.
Nursing home care for long-term stays: If you need to live in a nursing home for an extended period for custodial care, Medicare will not cover these costs.
Personal care services: Such as help with housekeeping, cooking, or transportation.
3. Medicare Coverage for Home Health Care:
While Medicare doesn’t cover long-term nursing home stays, it may cover limited home health care services if you are homebound and need part-time or intermittent skilled nursing care or therapy:
Skilled nursing care: Provided on a part-time basis.
Physical, occupational, or speech therapy.
Home health aide services: Covered if you are receiving skilled nursing care or therapy, but only for personal care tasks related to your medical treatment.
Limitations: Medicare only covers home health services if they are medically necessary and part of a plan of care created by your doctor. Personal care alone is not covered.
4. Medicaid and Long-Term Care:
Medicaid, a joint federal and state program, may cover long-term care or nursing home services for individuals with low income and limited resources. If you qualify for Medicaid, it may pay for custodial care in a nursing home or for in-home personal care services.
Eligibility for Medicaid long-term care services varies by state, so it’s important to check with your state’s Medicaid office to learn about specific requirements and benefits.
5. Alternative Options for Long-Term Care Coverage:
Since Medicare does not cover long-term custodial care, individuals may want to consider other options for long-term care needs:
Long-Term Care Insurance: Private insurance policies that cover services such as nursing home care, assisted living, and in-home care. These plans are purchased separately from Medicare and help cover the costs of long-term care services.
Personal Savings: Some individuals may need to rely on personal savings or other assets to cover the cost of long-term care.
Key Takeaways:
Medicare does not cover long-term care or custodial care in a nursing home.
Medicare Part A covers short-term skilled nursing care after a qualifying hospital stay, but coverage is limited to 100 days.
Medicaid or long-term care insurance may help cover the costs of long-term care.
For help understanding your coverage options for nursing home or long-term care services, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
