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Posted by LTC Staff
LTC Staff
Staff writers for LTC.com
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on Friday, 04 May 2012
in LTC Insurance

Will Medicare Pay for Long Term Care?

One common misconception about Medicare is that it will pay for Long Term Care services. In recent years, the United States Government has begun trying to dispel this myth. The Social Security Administration’s annual statements now include the following warning: “Medicare does not pay for Long Term Care, so you may want to consider options for private insurance.”

In some very specific instances, Medicare will pay a portion of Long Term Care costs. Receiving this benefit can be difficult as there are several conditions that must be met in order to qualify.

A) Skilled Nursing Facility (SNF) Medicare Part A

Medicare may pay for up to 100 days of skilled nursing facility (SNF) rehabilitation per 60-day benefit period if certain conditions are met. They are:

1. A three day (including overnight) hospital stay, not including the day of discharge from hospital.
2. The patient must transfer to the Medicare certified SNF within 30 days of discharge from the hospital for the same medical condition that resulted in the original hospital admission.
3. This transfer must take place within the same 60-day benefit period.
4. Admission to a SNF must be by doctor’s orders requiring skilled care.
5. Skilled care services must be provided on a daily basis.
6. The patient must demonstrate continuous medical improvement. Otherwise, the condition is considered chronic and the care custodial and, therefore, not covered.

Note: On average, just over half of people seeking SNF coverage from Medicare meet these qualifying criteria, and Medicare typically pays only 3-4 weeks of SNF daily charges.

B) Home Health Care (HHC) Medicare Part A

Medicare distinguishes between Home Health Care (skilled services) and Home Care, which it considers custodial care. Here are important coverage considerations:

1. Home Care (HC) can be provided only if skilled home health care is first prescribed by the physician in support of a skilled plan of care (HHC).
2. HHC services must be prescribed and verified by a physician as medically necessary, and must be provided by a Medicare approved and properly licensed agency or organization.
3. The patient must be homebound: unable to leave the residence without considerable and taxing effort.
4. You need skilled nursing care on a part-time (less than eight hours a day) and intermittent basis.
5. Medicare does not pay for 24-hour care at home, meals delivered to the home, homemaker services, or help with ADL’s when ADL assistance alone is needed.

As you can see, qualifying for the Medicare Long Term Care benefit can be very difficult and in most cases, Medicare would not come close to covering the cost of a Long Term Care stay. Long Term Care insurance is by far the more dependable option. If you would like more information about Long Term Care please call us at 1-800-432-0091 or fill out our online form to receive a free rate comparison.

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