Tag Archives: Term Care Medicare

Medicare and Long Term Care

Medicare and Long-Term Care

Quick…how are you going to pay the costs of nursing home, assisted living, or home care should you or a family member ever need one of them?

Medicare, right? Actually, that answer is almost always wrong. And, even if Medicare pays, it only pays part of the cost and only for a short while. Worst of all, it only pays for skilled nursing care following a three day/three night hospital stay. Think about how few people actually spend three full days in the hospital any more-it’s more likely to be three days and two nights, and then Medicare does not pay for follow-on nursing home (or similar) care, regardless of the illness or injury.

Very few people who need long-term or follow-on care need skilled nursing care-they need custodial care. If skilled care is needed, it is not usually needed for very long, and not many people meet the 72-hour hospital stay requirement anyway. Think about it-if you have a serious illness or injury (for example a hip fracture or bypass operation), you may be in the hospital for several days or weeks, but when you are released you rarely need skilled nursing care. You are far more likely to need help dressing or getting to appointments or cooking your meals, and may not be able to care for yourself and end up in a long-term care facility. But, the care you need is easily given by semi-skilled or unskilled workers-not RNs or other medical staff.

Assuming you need skilled nursing care, Medicare actually does pay for 20 days at 100% and days 21-100 at $128.00/day (more or less, depending on your state). That is nowhere near the average cost of a day in a nursing home or similar facility. Depending on whose statistics you use, a day in a long-term care facility costs $110-$300 or more.

Of course, you could buy a Medicare supplement plan, but that plan only supplements the benefits provided under Medicare. Since Medicare does not cover custodial or unskilled care, a Medicare supplement policy is not likely to be of much help.

So, what can you do? There are a few options.

First, many people will need long-term care, but many more won’t. If your family history doesn’t include stays in long-term care facilities, maybe you don’t need to do anything. But, if your medical condition is not as good as that of other family members, you might be the exception. So, gambling isn’t always a good idea.

If you have a pension, a house, and few other assets, Medicaid may well cover your expenses. It is a good idea to find out before the need arises. Keep in mind not all care facilities accept Medicaid, and those that do may put you in a separate area. And, you are very likely to have a roommate (and it is not likely to be your spouse!).

If you have substantial assets and are prepared to spend them if needed, just make sure you have checked out the various care facilities so your family knows where you want to go.

Finally, if you have significant assets above any pension payments, consider purchasing a long-term care insurance policy. It could be the best investment you ever make. And, in some states the premium may even be tax-deductible.

Each state has somewhat different coverages. It is useful to visit the www.medicare.gov site for complete, state-specific information.

Contact Brian Gruss 509-927-9200 about your options with Medcare and Long Term Care Insurance.