Medicare and Medicaid: Do They Pay for Long-Term Care?

If you’re planning for retirement, you probably already know that 65 is an important age. That’s when you become eligible for Medicare, the federal health care coverage provider for retirees. It’s a valuable resource that provides health care protection for millions of seniors. Its sister program, Medicaid, provides similar protection for those who have little income and few assets.

Over the decades since their inception, Medicare and Medicaid have been expanded to cover a wide range of services. Medicare Part B was added to cover hospitalizations. Part D, the most recent addition, provides coverage for prescription drugs. Medicare Advantage is a unique program that offers supplemental coverage.

However, there’s one growing area of assistance that doesn’t fit neatly into the Medicare/Medicaid menu of coverage. It’s long-term care. According to the U.S. Department of Health and Human Services, 70 percent of today’s retirees will need long-term care at some point. Many will need care for years.1

Does Medicare cover long-term care? Does Medicaid? The answer isn’t clear-cut. It depends on your type of coverage and the type of care you need. Below are guidelines on what each program covers. Keep in mind that these guidelines are evolving over time. As you’ll see, however, you’ll likely need additional funding outside of what’s provided by Medicare or Medicaid.

Medicare

Medicare provides coverage for medical treatment and services. Very often, long-term care is about custodial support and assistance. That’s an important distinction. Custodial care may involve things like bathing, meal preparation and mobility assistance. While those services may be important, they aren’t the same as treatment for a specific condition.

For Medicare to pay for care, skilled nursing has to be part of the services. The care usually must be provided in a skilled nursing facility and has to follow a hospitalization for a specific medical condition. Even under these circumstances, Medicare coverage is temporary. Below is the payment schedule for Medicare coverage:

  • Days 1-20: Full coverage
  • Days 21-100: Patient pays $170.50 per day
  • Days 100+: Patient pays all costs

There’s a slight change to this for 2019. Next year, some Medicare Advantage policies will offer coverage for in-home custodial care. The exact coverage will depend on the policy and the provider, so be sure to shop around to find the right policy for your needs and budget.

Medicaid Eligibility

Medicaid does offer coverage for stays in skilled nursing facilities. It will also, in some cases, cover in-home care if the person would be in a nursing facility without the care.

Medicaid eligibility comes with a catch, though. You must have little income and few assets to qualify. The exact formulas are complex and vary from state to state. However, you would generally need to deplete your own assets before counting on Medicaid coverage. While many seniors do use Medicaid at some point, it’s often at the end of life and after they’ve exhausted all other care options.

While Medicare and Medicaid may play a role in your long-term care strategy, you may not want to rely solely on those programs. Contact us today at Spicer Wealth. We can help you develop a funding strategy that meets your needs and budget. Let’s connect soon and start the conversation.

 

1https://longtermcare.acl.gov/the-basics/how-much-care-will-you-need.html

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18154 – 2018/10/17