Medicare is NOT Long-Term Care Insurance

Long Term Care Insurance

Long-Term Care is an essential product to have for many who will likely end up needing some form of custodial care before they pass away. It is essential for people to have an understanding of what Medicare will and will NOT cover when it comes to custodial care. Let’s take a look at some of the public's misconceptions.

In many cases, a patient may no longer require continuous hospital care but may not be well enough to go home right away. Consequently, Medicare Part A provides benefits for care in a skilled-nursing facility only “if” a physician certifies that skilled-nursing care or rehabilitative services are needed for a condition that was treated in a hospital facility within the last 30 days. In addition, this prior hospitalization must have lasted at least 3 full days. Only then will skilled-nursing facility benefits be paid in full for 20 days in each benefit period and from day 21-100 a daily co-payment of $157.50 (in 2015) is required.

A skilled-nursing facility may be either a separate facility for providing such care, or a separate section of a hospital or nursing home. The facility must have at least one full-time registered nurse, and these nursing services must be provided at all times. Every patient must be under the supervision of a physician, and a physician must always be available for any emergency care. One very important point should be made about skilled-nursing facility benefits: custodial care is NOT provided under any part of the Medicare program unless skilled-nursing or rehabilitative services are also needed and covered!

Therefore, it sounds good that if a patient can be treated at home for a medical condition that Medicare will pay the full cost for an unlimited number of home visits by a Medicare-approved home health agency. However, to receive these benefits, a person must be confined at home and be treated under a home health plan set up by a physician, and the care needed must include skilled-nursing services, physical therapy, or speech therapy. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse or other professional, such as a licensed physical therapist. In addition to these services, Medicare will also pay for the cost of part-time home health aides, medical social services, occupational therapy, and medical supplies and equipment provided by the home health agency. The only charge for these benefits is a required 20 percent co-payment for the cost of such durable medical equipment as oxygen tanks and hospital beds. Medicare does NOT cover home services that primarily assist people in activities of daily living (ADLs) such as transferring (from bed to chair), dressing, bathing, or toileting. It is important for people to understand that Medicare does NOT pay for any of the following:

• 24-hour-a-day care at home

• meals delivered to a patient’s home

• homemaker services such as shopping, cleaning, and laundry service

• personal-care given by home health aides like bathing, dressing, and toileting when this is the only care needed

Understanding the limitations of Medicare-provided services helps you to see why long-term care insurance (LTCI) is a critical part of many financial plans. LTCI will pay for long-term care and services, including purely custodial services, that Medicare does not cover.

About the author: Kyle McDonald holds FIC, FICF, FSCP® & CLTC designations. His viewpoint on life insurance is simple, “Anyone with a family must have life insurance. In the end, life insurance is for others you care about, not you.” He is ready to help you and your family get the best option available. Contact Kyle today at   1-800-651-1953 or KMcDonald@Pivot.com.