Medicare and Long-Term Care

Medicare is a federal program providing hospital and medical insurance to people 65 or older and to ill or disabled people who qualify. The benefits for nursing home care and home health care are very limited. Medicare's skilled care facility benefit does not cover most nursing home care. Medicare will cover some skilled care in a nursing home, or your home, but only in selected situations and the benefits are very limited.

In order to collect benefits from Medicare a medical professional must state that you have been in the hospital for three days and you need skilled care. It is important to remember not to rely on Medicare to pay for your long-term care needs.

Medicare does not cover homemaker services except in well defined circumstances. The only way for you to receive a home health aide to give you personal care is, if you are homebound, and you are also receiving skilled care, and the personal care must relate to the treatment of the illness or injury and you may only have a limited amount in any week.

There is Medicare supplemental insurance (referred to as Medi-Gap insurance) which is private and which pays some of the gaps in Medicare coverage. These policies do not cover long-term care costs. However, there are four policies, plans D, G, I, and J that will pay up to $1,600 per year for services to people recovering at home from an illness, injury, or surgery. These plans are for short term though they will pay for help at home with activities of daily living. An individual must qualify for Medicare home health care services before the Medicare supplement benefits are available.

Source:
National Association of Insurance Commissioners, 1999