At some point, living on your own may become unsustainable. Whether it’s due to illness or old age, it can happen to the best of us. Luckily, the Medicare program can help cover many of your health care needs. While this coverage can lessen many of the health care costs you face, it doesn’t help with all of them. What if you experience an unexpected health event and require care for an extended period of time?
Medicare.gov defines long-term care as “a range of services and support for your personal care needs.” Many times, long-term care is for assistance with everyday tasks. These services are not considered medical care; instead, they’re considered custodial care. With that in mind, does Medicare insurance cover long-term care?
Does the Medicare Program Cover Long-Term Care?
We won’t hold you in suspense. Most of the time, the answer is no, especially if you only need custodial care.
Medicare insurance will not cover long-term care that’s only required for help with activities of daily living, like bathing, dressing, eating, and using the bathroom.
Medicare insurance will not cover long-term care that’s only required for assistance with activities of daily living, like bathing, dressing, eating, and using the bathroom. It also won’t help pay for basic health care that most people can do on their own, like administering eye drops. So, if you live in a nursing home or have a home health care provider strictly for help with these types of tasks, it’s likely you’ll be responsible for paying for them on your own. That’s not to say that the Medicare program is completely useless in helping to pay for long-term care, though.
Medicare insurance generally helps cover medically necessary services that can include long-term care support. One example of this could be skilled nursing facility care. When they become medically necessary, Medicare Part A may cover your meals, a semi-private room, and prescription drugs, among other things. You wouldn’t have to pay anything for days one through 20 in the skilled nursing facility. After 20 days, you’d pay a $204 coinsurance in 2024 each day up until, and including, day 100. After 100 days, you’d pay for all costs.
Medicare insurance generally helps cover medically necessary services that can include long-term care support, though this is rarely an option for longer than a few months.
Besides select nursing home care, Medicare insurance also helps pay for care in a long-term care hospital and certain home health services. Additionally, there are options that the Medicare program offers that may cover certain long-term care services — if you qualify. These programs are hospice care and PACE.
In order to get hospice care or join PACE, your doctor needs to approve either service. Neither of the programs are permanent solutions, though. Hospice care is usually only for individuals who have a life expectancy of six months or less. Should you outlive that diagnosis, you can be recertified as needing care. In some cases, PACE’s long-term care benefits may not be premium-free. Unless you are also enrolled in Medicaid, you’ll be expected to pay premiums for PACE long-term care benefits.
What Are My Other Coverage Options?
Since Medicare insurance can’t cover long-term care, it may seem difficult affording these services. Don’t fret! You’ve still got plenty of options.
If you have the money, you can rely on your own personal savings. This makes a smart savings and funding plan for your retirement especially important. If you have a health savings account (HSA), you can use money from that to cover qualifying long-term care services. Another option is using money from your Medicare Medical Savings Account (MSA), if you have one. These are high-deductible Medicare insurance plans with a connected banking account that you can use to pay for medical costs. Many MSA plans will help cover long-term care costs covered by Medicare insurance and some that aren’t.
To qualify for long-term care coverage through Medicaid, you must be enrolled in the program and meet functional standards as certified by a state medical specialist.
It may also be worth investigating whether you qualify for Medicaid, and if so, whether you’re eligible for long-term care coverage. Eligibility requirements for Medicaid can vary from state to state. To qualify for long-term care coverage through Medicaid, you must be enrolled in the program and meet functional standards as certified by a state medical specialist. One such coverage program that we mentioned is PACE. If you have Medicaid and qualify for PACE, your long-term care services may be covered. Certain long-term care services may also be covered by other programs through Medicaid, depending on eligibility.
Another way you can afford long-term care is if you have long-term care insurance. Different forms of long-term care insurance are offered by many reputable companies. These types of plans are designed to cover many of the long-term care expenses you may incur in the future. Each plan is different, though, so you’ll want to read the fine print before enrolling. Some long-term insurance plans will cover everything from skilled nursing home care to adult day care to home health care. When deciding on one, it’s important to consider the cost (since most plans have premiums), your needs, and what the plan covers.
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Looking to learn more about long-term care and your options? Check out LongTermCare.acl.gov. This website, managed by the U.S. Department of Health & Human Services, has a large library of resources and guides on long-term care, from planning tips for the services to finding services near you. So, even though Medicare insurance doesn’t directly cover long-term care, you have many options out there to help you with what you need!