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Does Medicare Cover Long-Term Care? Understand what is covered!

Does Medicare Cover Long Term Care?
Kevin Wenke

Kevin Wenke

Owner at Decision Tree Financial. CFP. CLU

There are some ways that Medicare covers long-term care services. Medicare will help on a short-term basis with declining coverage.

If you, or someone you know, is on Medicare and you want to know, “Does Medicare cover long-term care services? 

The answer is, “Sort of, it depends.”

Medicare has the potential to pay 100% of your long-term-care-type needs IF you are prescribed HOSPICE by two licensed doctors.

Hospice is care that focuses on making a terminally ill individual comfortable. Hospice no longer provides any services toward patient recovery.  While it can last years, hospice is generally prescribed to an individual when they are expected to live only six months or less.

Does Medicare Cover Long Term Care?

However, Medicare will help an individual who… and this is key… was just released from a hospital after a three day stay and requires help with activities of daily living (ADLs) after they are discharged to help them recover

If this is the case, Medicare will pay 100% of LTC type services for 20 days after a hospital discharge.  After day 20 to day 80 a daily deductible payment of 1/8th the hospitalization deductible (So that would be 1/8th of $1,484 ($185.50) each day in 2021.  After 100 days, there are no additional benefits for skilled nursing.

Days After Hospital StayMedicare Coverage
1-20100%
21-100$185.50/Day Coinsurance
100 +No Coverage
Figure 1.

For example, if you are a Medicare beneficiary and you are admitted to a hospital after you fall on the ice and break your leg, or even have a mild heart-attack, you may be in the hospital for a few days or weeks.  Once you are out of the hospital, you have some level of coverage for up to 100 days (Figure 1.)

Knowing this, most people who invest in long-term care insurance have coverage for chronic conditions will buy a policy with a 100-day waiting period before coverage starts. This reduces the cost of a policy when compared to one that starts coverage immediately. The idea here is that Medicare will pay something for the first 100 days and the insurance policy picks up after Medicare is exhausted.

So, does Medicare cover long-term care?  Sort of – but expecting Medicare to pick up your long-term care costs is not a good strategy!  A good start to finding your solution can come from downloading my book, The Secret to Long-Term Care Planning.

In this easy-reading book you will find information you need to know… but more importantly the SECRET to how to use that information!

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