Does Medicare Cover Long Term Care? – Overview
One of the most important decisions you will make as you think about your future is whether to include a plan for long term care (LTC) in your retirement plan.
Long term care includes a range of services and support that people may need if they are unable to perform certain activities on their own due to a chronic illness, disability or cognitive impairment.
These services and supports help people with their daily living tasks, such as eating, bathing, dressing, toileting and continence.
The need for long term care is not limited to older adults. Almost half of the people who receive long term care today are under age 65. But the need for long term care increases with age.
More than half of those over age 85 will require long term care at some point in their lives.
Why Do You Need Insurance Coverage for Long Term Care?
Long term care is expensive, especially when it involves professional home health or nursing home services.
While Medicare covers short-term skilled nursing facility stays and some home health care, it does not pay for the type of ongoing assistance that many people need throughout the course of a year.
Will Medicare Cover Long Term Care?
Medicare generally doesn’t cover long-term care. The closest it comes is paying for inpatient rehab or skilled nursing care following a hospital stay.
However, you can pay out-of-pocket for a long-term care insurance policy that covers non-medical services.
You can also tap assets such as a reverse mortgage to cover long-term expenses or consider getting another type of coverage that will pay for most health expenses even if you need long-term care.
Medicare and Long Term Care
Traditional Medicare covers doctor visits, hospital stays and some other medical needs, but it doesn’t pay for help with daily living activities such as bathing, dressing and housekeeping.
Medicare Part D helps pay for prescription drugs, but only if your doctor prescribes them. These gaps make traditional Medicare a poor choice for seniors who need daily assistance.
Long-Term Care Coverage
The best way to get coverage for long-term care is through a private insurance policy that pays a set amount per day for a certain number of years to cover the costs of professional assistance at home or in an assisted living facility.
The premiums are usually based on your age when you buy the policy, so delaying the purchase won’t necessarily save you money later on.
Medicare covers some long-term care services, but not all of them and here’s what you should know.
If you need long-term care, it’s important to understand exactly what Medicare does and does not cover before deciding how to pay for your services.
It can be very confusing because Medicare has different programs:
Part A — Hospital benefits, including inpatient hospital care, skilled nursing home care (not custodial or long-term care), some home health care and hospice care
Part B — Medical insurance that pays for doctors’ services, outpatient hospital care, medical supplies and equipment and some other services that aren’t covered by Part A
Part C — Also known as Medicare Advantage Plans. These plans provide coverage through private insurance companies to people who are eligible for Parts A and B.
They generally include Parts A and B benefits plus additional benefits not covered by Medicare such as prescription drug coverage (Part D) and routine dental and vision services.
Part C plans also may provide more extensive coverage than Original Medicare for certain services such as hearing aids, routine foot care and eyeglasses.
People enrolled in a Part C plan must continue to pay the monthly premium for Part B coverage, but generally have a lower out-of-pocket cost than those who have Original Medicare.
Who is Eligible for Medicare’s Long Term Care Cover?
You are eligible for long term Medicare cover if:
- You have a permanent disability.
- You are under the age of 65 and a United States citizen or permanent resident.
- You have been receiving Social Security Disability Insurance (SSDI) benefits.
If you qualify for Medicare due to disability, you will be covered automatically by Part A and Part B after 24 months of receiving disability benefits from Social Security or the Railroad Retirement Board.
Typically, you will receive your red, white and blue Medicare card in the mail three months before your 25th month of eligibility.
Knowledge is power. If you or a loved one is in need and wondering if Medicare will cover the same, then this article is for you.
You are now in a better position to decide whether to go for Medicare or look for another cover.