Doesn’t Medicare Pay for Nursing Homes and Long Term Care?

Most seniors have a general understanding that at some point they’re going to be on Medicare, and that Medicare is generally good at meeting most of their needs. Here at Long Term Care Resources Pacific Agency (LTCR Pacific), we’ve helped many seniors get the right Medicare coverage for their needs and finances, and we encourage you to reach out to us for personalized service.

But while Medicare may meet many of your needs as you get older, one thing it does not cover is something that many of us end up needing: long term care. That is why it is so important for nearly everyone to obtain long term care insurance as they get older, ideally before they’re on Medicare and before they are likely to have long term health issues.

About Long Term Care

The term “long-term care” refers to a range of services and supports necessary for individuals who can no longer perform everyday activities independently. These services can include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and mobility. Long-term care can be provided at home, in assisted living facilities, or in nursing homes.

Essentially, long term care is care that takes place outside of a hospital, with medical professionals or care workers that are expected to continue to provide services for months, years, and often the rest of an individual’s life.

Medicare Coverage for Long Term Care

Most seniors, after they retire, are on Medicare. Medicare will pay for many of the medical procedures a person needs when they are older. It does cover a small amount of medical care associated with long term care, such as:

  • Short-Term Skilled Nursing Care – Medicare Part A covers short-term skilled nursing care if it follows a hospital stay of at least three days. This coverage is typically limited to a maximum of 100 days per benefit period, with full coverage for the first 20 days and a copayment required for the remaining days.
  • Home Health Care – Medicare covers some home health care services if they are medically necessary and prescribed by a doctor. These services may include skilled nursing care, physical therapy, and occupational therapy. However, this coverage is generally limited and does not extend to long-term personal care or assistance with ADLs.

Should you also need immediate medical care while you’re on long term care, Medicare may cover that as well. Medicare is an amazing service, and does cover many medical needs.

However, it falls very, very short when it comes to long term care. For that, you need Medicaid, but Medicaid only kicks in when you have no more in savings, and even then it may not cover the care you need.

What Medicare Does Not Cover

Medicare does not cover the long term care needs that most people have when they are no longer able to care for themselves. It does not cover:

  • Custodial Care – Medicare does not cover custodial care, which is non-medical care that assists with ADLs. This type of care is often needed on a long-term basis and can be provided at home or in a residential setting.
  • Assisted Living – Medicare does not cover the costs associated with residing in an assisted living facility. These facilities provide personal care and support services, but the expenses must be paid out-of-pocket or through other insurance plans.
  • Long-Term Nursing Home Care – While Medicare covers short-term stays in skilled nursing facilities, it does not cover the costs of long-term nursing home care. Residents must rely on personal savings, long-term care insurance, or Medicaid for extended stays.

If you need any type of care at home, like a private nurse, Medicare will not cover it. If you need long term care, you’re likely to pay for it out of pocket unless you have a plan in place to help you with the costs.

How to Pay for Long Term Care

Most of us will need long term care at some point in our lives. But with the costs so expensive all over the United States, and given the limitations of Medicare, individuals may need to explore alternative options for funding long-term care.

The single best option for long term care when you have Medicare is long term care insurance. Long term care insurance is designed to cover the costs of long-term care services. This type of insurance is specifically designed to address the costs of long term care for an extended period of time with policies able to cover expenses for in-home care, assisted living, and nursing home care.

Keep in mind that our team at Long Term Care Resources Pacific Agency, also known as LTCR Pacific, has discounts on long term care insurance products not available anywhere else, and is specifically an expert in long term care insurance. If you want personal support for long term care insurance that you cannot get anywhere else, LTCR Pacific is your best choice.

Without LTC insurance, you’d typically be required to cover the costs of long term care with:

  • Retirement Investments – Your retirement investments are going to be the first place that people turn to cover the costs of long term care. If you have an outstanding amount of retirement, this could last you a while, but most people do not have a sizeable retirement to help them pay for long term care.
  • Personal Savings – Similarly, long term care will likely come out of personal savings accounts, either of yourself or your family.
  • Medicaid – Medicaid is a joint federal and state program that provides health coverage for low-income individuals, including long-term care services. Unlike Medicare, Medicaid covers custodial care and long-term nursing home stays. Eligibility and coverage vary by state, and individuals must meet specific income and asset requirements to qualify.
  • Other Government Programs – Some veterans may qualify for long-term care benefits through the Department of Veterans Affairs (VA). Additionally, certain state and local programs may offer assistance with long-term care services.

Typically, the eligibility requirements for Medicaid require you’ve nearly exhausted your personal savings account and retirement investments first, which is why it is not considered an ideal choice. If you planned to pass any assets down to your heirs, for example, that is much less likely if you need long term care.

Invest in Long Term Care Insurance to Protect Your Assets

Medicare pays for many services, and is an outstanding government program, but it does not cover everything. Long term care insurance is the best investment you can make if you want to protect these assets and make sure that you have the financial support you need to cover the costs of long term care. If you’re looking for long term care insurance, contact LTCR Pacific, today.

Leave a Comment

Your email address will not be published. Required fields are marked *

Skip to content