Medicare and Long-Term Care

nurse with elderly woman
Lori Gubash, CLTC, FICF
Lori Gubash, CLTC, FICF October 13, 2023

Lori leads the LTC team and acts as a liaison to ensure we are providing the best possible Long-Term Care Insurance and business development solutions for our agents and their senior clients.

October 15 brings the beginning of Medicare Open Enrollment, which runs through December 7. One of the most frequently misunderstood benefits of Medicare is long-term care. This type of care, also known as custodial care, includes medical and non-medical assistance for people with a chronic illness or disability. Most long-term care is related to a person’s activities of daily living. Although many Americans believe Medicare will pay for their long-term care expenses, the reality is Medicare and most health insurances (including Medicare Supplements) do not typically cover long-term care.

Medicare and Skilled Nursing Facilities

It’s important to note that Medicare does provide coverage for a skilled nursing stay if it is preceded by an inpatient hospital stay of at least three days. In these cases, Original Medicare will cover days 1-20 in a skilled nursing facility at no cost. If Medicare-approved, days 21-100 will be partially covered with a co-pay of $200 per day in 2023 ($204 in 2024). However, if the hospital stay is less than three days or if any part of the three days is considered observation, Medicare will not provide coverage. In addition, for Medicare to continue covering skilled nursing care, the patient must show measured improvement from therapies and care. Otherwise, Medicare will discontinue the coverage.

Read More: Does Medicare Cover Long-Term Care?

Medicare and Home Health Care

Original Medicare will also cover part-time and intermittent home health care services if the beneficiary is homebound and cannot leave their home without tremendous effort. These services include skilled nursing care, physical therapy, occupational therapy, speech therapy, durable medical supplies, and equipment. It does not include 24-hour care in the patient’s home, meals delivered to their home, or personal care, such as bathing, dressing, or using the bathroom. Additionally, the patient needs to make measured improvements in order for Medicare to continue covering these services.

The Importance of Planning for Long-Term Care

For anyone who needs care beyond the Medicare-covered allotment, they must have a plan in place for it. A plan should include how they will pay for care and who will provide it. Are your clients prepared? It’s vital that your clients have this plan decided upon before they need care. That way, their loved ones are prepared prior to an event occurring. In many cases, if your client has assets at risk, having a long-term care insurance (LTCI) policy may be in your client’s best interest since it offers the most flexibility while also providing financial peace of mind.

Read More: Creating a Plan for Aging

The best time to plan is now! Ask your clients if they have a plan in place to pay for their long-term care. The earlier you have this conversation with your clients, the more options they have and the lower their premiums. While Medicare does cover a very limited amount of long-term care, it’s not something your clients should count on to take care of these needs. It’s best for your clients to purchase an LTCI policy before it’s too late.

To discuss your client’s options for Medicare or long-term care insurance, we invite you to schedule a call with one of our staff members.