Why You Can’t Count on Medicare to Pay for Long-Term Care

Are you nearing retirement? If so, you’re probably putting together the final pieces of your financial strategy. You may be considering when to file for Social Security, how you’ll generate income and possibly even what your budget should look like.You also may be thinking about health care coverage. It’s likely that Medicare will play an important role in your retirement. Medicare is a valuable retirement resource that provides health care protection for 44 million Americans, or 15 percent of the population.1

Medicare covers everything from hospitalizations to doctor’s appointments and even prescription drugs. You can utilize Medicare Advantage to obtain coverage for even more services, like physical therapy and dental treatment.

It doesn’t cover every service, though. Long-term care is one common health care service that is often not covered by Medicare. That can be a problem, because long-term care is also widely needed by retirees. The U.S. Department of Health and Human Services estimates that today’s 65-year-olds have a 70 percent chance of needing long-term care in the future.2

Unfortunately, it’s not always clear whether care is covered by Medicare. That can make it difficult to plan. Below are a couple of questions you should ask to help you better understand whether your long-term care would fall under Medicare coverage:


Is the care skilled nursing or custodial care?


Medicare will partially and temporarily cover some forms of long-term care. However, it depends on the exact nature of the care. Medicare pays for skilled nursing care but usually doesn’t pay for custodial care. That’s an important distinction.

Skilled nursing care includes medical treatment for a specific condition. The care is usually prescribed by a doctor and administered by a skilled nurse. While skilled nursing may include some forms of custodial care, such as help with eating or bathing, the purpose of the care should be treatment and recovery.

Custodial care usually doesn’t include medical treatment. It involves assistance with basic living activities like mobility, eating, incontinence and more. The goal of custodial care is usually comfort and lifestyle support, primarily because the individual is at a stage where recovery isn’t an option.

Most of the time, long-term care involves far more custodial care than skilled nursing. Many recipients of long-term care suffer from issues such as Alzheimer’s. That means there won’t be a recovery and no specific treatments are available. Medicare usually doesn’t cover this kind of support.


Is the care provided in your home or a facility?


Another important factor is where the care is provided. Long-term care is often provided in the home, which usually isn’t covered by Medicare. Starting in 2019, however, some Medicare Advantage plans will cover certain types of home-based care.

It’s also possible that you could receive care in an assisted living facility or nursing home. Again, Medicare coverage depends on the reason for care and the type of care that’s provided.

Medicare will temporarily cover skilled nursing care in a facility if it follows a three-day stay in a hospital as a result of a specific medical condition.3 For example, if you are hospitalized for a stroke, you may need to stay in a facility for care while you recover. That type of long-term care could be covered.

Depending on the length of the skilled nursing care, you’ll likely share the cost with Medicare. The coverage schedule breaks down as follows:

  • Days 1-20: Full Medicare coverage
  • Days 21-100: Partial coverage depending on deductibles and copays
  • Days 100+: No Medicare coverage3

As you can see, Medicare is unlikely to meet all of your long-term care needs. It may be wise to develop an alternate funding strategy, perhaps including a long-term care insurance policy. Contact us today at Protecting Your Retirement at 913.648.2700 for more information. We can help you analyze your needs and budget, and then implement a plan.






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18148 – 2018/10/17