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Planning for Long-Term Care: What Medicare Covers

Planning for long-term care is a critical aspect of retirement and healthcare planning, yet many individuals are uncertain about what Medicare covers in this context. Long-term care encompasses a range of services and support for individuals who need assistance with activities of daily living due to chronic illness, disability, or cognitive impairment. In this post, we’ll explore what Medicare covers regarding long-term care and provide insights into additional planning strategies for this important aspect of healthcare.

Understanding Long-Term Care

Long-term care refers to a variety of services designed to meet the personal care needs of individuals who have difficulty performing everyday activities independently. These services may include assistance with bathing, dressing, toileting, eating, and mobility. Long-term care can be provided in various settings, including nursing homes, assisted living facilities, and home care settings.

What Medicare Covers

  • Skilled Nursing Facility Care

    Medicare Part A provides coverage for a limited period of skilled nursing facility care under specific circumstances. To qualify for Medicare coverage of skilled nursing facility care, beneficiaries must meet the following criteria:

    • Have a qualifying hospital stay of at least three consecutive days.

    • Require skilled nursing care or rehabilitative services on a daily basis.

    • Enter a Medicare-certified skilled nursing facility within a certain timeframe after their hospital discharge.

    Medicare Part A covers the first 20 days of skilled nursing facility care in full. For days 21 through 100, beneficiaries are responsible for a daily coinsurance amount. After day 100, Medicare coverage ends, and beneficiaries are responsible for all costs.

  • Home Health Services

    Medicare Part A and Part B cover limited home health services for beneficiaries who are homebound and require skilled care on an intermittent basis. Covered home health services may include:

    • Skilled nursing care

    • Physical therapy

    • Occupational therapy

    • Speech-language pathology services

    • Medical social services

    • Part-time or intermittent home health aide services

  • Hospice Care

    Medicare Part A provides coverage for hospice care for beneficiaries with a terminal illness who have a life expectancy of six months or less. Hospice care focuses on providing comfort and supportive services rather than curative treatment. Covered hospice services may include:

    • Pain relief medications

    • Counseling

    • Medical equipment and supplies related to the terminal illness

    • Respite care for caregivers

What Medicare Does Not Cover

While Medicare provides some coverage for long-term care services, it does not cover all aspects of long-term care. Medicare does not typically cover:

  • Long-term custodial care in nursing homes or assisted living facilities.

  • Room and board in nursing homes or assisted living facilities.

  • Most non-medical personal care services, such as assistance with bathing, dressing, and eating, when they are not associated with skilled nursing care or rehabilitative services.

Planning Strategies for Long-Term Care

Given the limitations of Medicare coverage for long-term care, it’s essential for individuals to explore additional planning strategies to address their long-term care needs. Some strategies to consider include:

  • Purchasing long-term care insurance to help cover the costs of custodial care in nursing homes or assisted living facilities.

  • Setting aside funds in a dedicated savings account or investment portfolio to cover future long-term care expenses.

  • Exploring Medicaid eligibility and planning options for individuals who may need to rely on Medicaid for long-term care coverage in the future.

While Medicare provides some coverage for certain long-term care services, it’s important for individuals to understand the limitations of this coverage and explore additional planning strategies to address their long-term care needs. By understanding what Medicare covers and planning ahead for potential long-term care expenses, individuals can take proactive steps to ensure they have the resources and support they need to maintain their health and independence in the years to come. Here at the J G Petit Insurance Agency we can make sure that you have the right policies for your individual circumstances. Call us today on (855) 509-0001 to speak to a Licensed Insurance agent or book an appointment to get make sure you have the long-term care you may need.

We do not offer every plan available in your area. Currently we represent AETNA, United Healthcare organizations which offer AETNA: MA and PDP and United Healthcare: MA, PDP, CSNP, DSNP products in your area. Please contact Medicare. gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

Not affiliated with or endorsed by the government or Federal Medicare Program. J G Petit Insurance sales agents not affiliated with the government.

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John Petit

John has a degree in Finance, a Master’s degree in Management, and is licensed to offer insurance products, financial products such as mutual funds and retirement plans.

Published March 22, 2024. Updated May 28, 2024

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