When you think of long-term care, do you see assisted living or nursing home facilities? According to Longtermcare.gov, around 70 percent of us will need some form of long-term care. Nursing homes can offer nursing care and 24-hour supervision, and other facility options include assisted living, board-and-care homes, and continuing-care retirement communities. But, when possible, you’ll probably want to stay at home with help from nurses, home health or home care aides. You may even need a therapist who comes to your home.
What You May Not Know about Medicare
Original Medicare only helps with skilled nursing facility care in limited circumstances. First you must be officially admitted to a hospital and stay for at least three days before Medicare will cover skilled nursing and rehabilitative services, and other medically‑necessary services and supplies for a related illness or injury. And, those three days start the day you’re admitted with a doctor’s order and don’t include the day of your discharge.
The second requirement is that a doctor must certify you need skilled care on a daily basis. That could be something like intravenous injections or physical therapy.
If you quality, Medicare will cover up to 20 days of skilled nursing care after you meet the Part A deductible. In 2013, that’s $1,184. It’s not an annual deductible, though. It’s tied to a “benefit period.” That begins when you are officially admitted to a hospital (being held for observation doesn’t count), and it ends when you haven’t received care from a hospital or skilled nursing facility for at least 60 consecutive days.
If you need to stay beyond those initial 20 days, you’ll be charged $148 a day up to the 100th day. Medicare provides no more help after that unless you start another benefit period.
What You May Not Know about Medicaid
This is a joint federal and state program, so whether or not you can qualify depends a lot on your state government. Medicaid pays for certain health services for those with limited income and resources.
Certain people may qualify for federal programs like the Older Americans Act or Veterans Affairs, but many people can only depend on the long-term-care insurance they purchase.
What You May Not Know about Long-term Care Insurance
This is independent of federal and state laws. It’s private insurance and it can help with both non-skilled and skilled care. What you probably don’t realize is that coverage can vary widely. Policies may cover care through adult day care, assisted living facilities, informal home care and/or formal nursing facility care. Of course, the more types of coverage you have, the better prepared you’ll be. To help you sort it all out, MediGap Advisors’ Robin Frank specializes in long-term-care insurance.
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.