senior health center/senior health a-z list/medicare coverage: long-term care article

Long-Term Care

Last Editorial Review: 12/9/2005

WebMD Medical Reference

Long-term care refers to social, medical and personal services for people who need help for a long time due to old age or disability. Medicare covers medical needs, but does not pay for social and personal services such as:

  • Bathing
  • Dressing
  • Eating
  • Moving around
  • Using the bathroom

What Medicare Covers

Skilled Nursing Facility Care

  • Medicare helps to pay for your recovery in a skilled nursing facility after a three-day hospital stay. For more details on what this includes and what it costs, see What Does Medicare Cover?
  • Medicare will cover the cost of skilled nursing care for a maximum of 100 days. As soon as you no longer need daily skilled nursing care, Medicare stops paying.

Home Health Care

  • If you are home bound and your doctor says you need short-term skilled care, Medicare will pay for nurses and therapists to provide services in your home.

To learn more about what home health care benefits include, see What Does Medicare Cover?

The aim of home health care is for you to recover from an illness or injury. Home health aide services and skilled nursing care must be given on a part-time or intermittent basis. To qualify, you must need care

  • On fewer than seven days in a week, or
  • For less than eight hours a day

over a period of to 21 days. There are exceptions in special cases.

You may qualify for more care if your doctor can say when you will recover. Once you have begun to get home health services, you may keep getting them:

  • For less than eight hours a day,
  • And
  • For 28 hours or less each week (up to 35 hours in some special cases).

Medicare will stop paying for home health services when you recover.

Hospice

Medicare covers hospice care. Hospice is care you get to make you more comfortable when you are in the last stage of life with a terminal illness. You are eligible if you are not being treated for your terminal illness, and your doctor certifies that you probably will live no longer than six months. You can get care for longer than that as long as your doctor says you are terminally ill. For more information on what is included, see What Does Medicare Cover?

What Is Long-Term Care?

Long-term care includes:

  • Nursing home care
  • Home care
  • Assisted living
  • Adult day care

This is care you receive indefinitely -- not just the time it takes to recover from an illness or injury. Long-term care may or may not include medical services.

How to Pay for Long-Term Care

Long-term care can be very expensive. You have three main options for paying. You may use:

  • Your personal savings
  • Long-term care insurance
  • Medicaid

Personal Savings

Many people have no choice but to pay all their costs because their assets are too high to get help. But once they spend what they have, they then apply for financial help.

Long-Term Care Insurance

One way to offset the cost of long-term care is to buy insurance ahead of time. Many insurance companies sell long-term care policies.

The earlier you buy a policy, the better. This chart from 2003 shows what an insurance policy may cost, based on when you buy:

Buyer Age Approx. Annual Cost
40 $640
50 $850
65 $1,700
79 $5,800

Source: American Association for Long-term Care Insurance. Premiums vary depending on benefits covered.

  • You may also be able cash in your life insurance early to pay for long-term care.
  • Some government employees and military people may be eligible for discounted group insurance.

Medicaid

  • You may qualify for help from Medicaid if your income or personal assets are below a certain amount.
  • If you qualify for both Medicaid and Medicare, almost all of your nursing home costs should be covered. Medicaid may also pay for home and community-based services if you are eligible for a nursing home but want to stay at home.
  • Medicaid programs are run by individual states. To learn more about your state Medicaid program, visit the Centers for Medicare and Medicaid Services web site.

Reviewed by Cynthia Haines, MD, August 2005.

SOURCES: Centers for Medicare and Medicaid Services. Medicare.gov web site. National Council on the Aging web site.

© 2005 WebMD Inc. All rights reserved.

For additional Medicare information, please read the following articles:

  • New Benefits At-a-Glance
  • Enrolling in Medicare
  • Medicare Coverage
  • Drug Discount Cards
  • Drug Benefits in 2006
  • Medigap
  • Retiree Benefits
  • Medicare for People with Disabilities
  • Decisions: What's The Right Coverage for You?
  • Filing a Medicare Claim
  • Getting More Information

QUESTION

What percentage of the human body is water? See Answer

Health Solutions From Our Sponsors