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Need A Nursing Home? Don’t Count On Medicare.

Approximately seventy percent of the Americans over the age of 65 will require long-time care at some point of their lives. But long-term care costs thousands of dollars a month, and not everybody has long-term care insurance. Many citizens assume that Medicare, the federal health insurance program for citizens aged 65 and above, will cater for these costs, but the truth is it does not.

Does Medicare pay for anything?

Medicare does not pay for long-term care, but will pay for essential skilled nursing in a home or other facility. But much of the care that elders require involves daily non-medical care, which can include diabetes monitoring, using the washrooms, bathing and dressing. These duties are designated as “custodial care” because they do not require any professional skill, and this is why Medicare doesn’t pay for them. (There are, however, some Medicare Advantage plans that provide skilled care coverage in a skilled nursing facility when it is medically necessary.)

Medically necessary coverage only

The coverage that Medicare provides is post-acute home health care and skilled nursing facility benefits. Normally, these are outpatient treatment-- therapy services and skilled nursing that patients require after being discharged from the hospital. For instance, Medicare would cover required wound care and physical therapy after a thigh injury. However, the federal health insurance program would only covers this for up to 100 days, and only if the patient had previously been admitted to a hospital for three or more days. Even for those that qualify for the 100 days of Medicare, however, the program only pays 100% for the first 20 days, after which you would be expected to pay a daily charge of $157.50 (unless you have Medicare supplemental insurance).

What About Medicaid?

Only Medicaid, not Medicare, offers long-term custodial care. However, coverage for this is restricted to people in a limited low-income bracket. For a person who lacks a sound long-term care strategy, the cost of long-term health care can become a huge burden relatively quickly. It is advisable, therefore, to forge a long-term care plan in your overall financial plan before you need it. 

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