Medicare Long Term Care Coverage

Does Medicare Cover Long Term Care?

No, Medicare does not pay for Long Term custodial care or private-duty home nursing.

If you or your loved one require custodial care due to a chronic condition, Medicare will not pay for custodial care. You would have to use a standalone Long Term Care policy or spend down all of your assets to qualify for Medicaid.

Since Medicare does not cover Long Term Care, neither do Medicare supplements nor Medicare Advantage plans.

Also, Medicare does not pay for Assisted Living circumstances.

Does Medicare Cover Nursing Homes?

Medicare offers a limited benefit for approved skilled nursing facility coverage.

First, a hospital must have discharged you within the past 30 days. You could not qualify for skilled nursing care unless you were recently hospitalized.

Second, skilled nursing care is only intended for temporary recovery after a hospital stay. You must have a medically-necessary reason to require skilled nursing, such as rehabilitation from joint replacement or cardiac surgery.

Third, your physician must prescribe skilled nursing under the assumption your condition will resolve within 60 days.

What Are the Medicare Skilled Nursing Limits?

Depending on the length of your stay at a skilled nursing facility, Medicare might require you to pay some of the costs.

If you have a qualifying stay, Medicare Part A covers the first 20 days in full. You do not need to pay any coinsurance.

After 20 days, from Day 21 to Day 100, Medicare requires you to pay $176 per day out-of-pocket. After day 100, Medicare ceases coverage, and you are responsible for paying 100% of all expenses.

What Does Medicare Skilled Nursing Include?

Medicare Part A nursing home benefits include:

  • Skilled nursing care
  • Meals
  • Semi-private room (shared with another patient)
  • Medications
  • Physical and occupational therapy
  • Speech-language pathology services
  • Dietary counseling
  • Ambulance transportation to the nearest supplier of needed services
  • Medical supplies and equipment used in the facility
  • Medical social services

How Does Medicare Cover Drugs In a Nursing Facility?

Typically, the nursing facility fills the prescriptions in-house. Medicare Part D (prescription drug coverage) applies to these costs.

You can change to a different Medicare Part D plan while in a nursing facility. Also, when you leave the facility, you can switch plans.

Does Medicare Include Hospice Care?

Yes, Medicare Part A includes comprehensive Hospice coverage, including:

  • Doctor services
  • Hospice aide and homemaker services
  • Grief and loss counseling for you and your family
  • Medical equipment (like wheelchairs or walkers)
  • Nursing care
  • Medical supplies (such as bandages and catheters)
  • Prescription drugs for symptom control or pain relief (you may need to pay a small copayment)
  • Speech-language pathology services
  • Physical and occupational therapy
  • Social worker services
  • Dietary counseling
  • Short-term respite care (may need to pay a small copayment)
  • Short-term inpatient care (for pain and symptom management)
  • Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team

How Much Does Medicare Charge For Hospice?

Medicare Part A pays for most of Hospice care services and treatments, including:

  • 100% of hospice services
  • Cost of prescription drugs, less $5 copay needed to provide comfort and control pain related to the terminal illness
  • 95% for inpatient respite care

What is Hospice Respite Care?

Respite care is for caretakers. It gives them a temporary break from caring for their loved ones receiving hospice therapy.

Respite care temporarily moves the hospice patient in a Medicare-approved facility like a hospice inpatient facility, hospital, or nursing home.

Medicare covers respite care for up to 5 days for each stay.

AARDY Can Help

AARDY is the nation's fastest Medicare insurance marketplace. You can compare Medicare supplements and Medicare Advantage plans to find the one that best fits your needs.

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