What You Should Know About Long-Term Care

Introduction

Cost of Care

Risks

Who Pays

Medicare

Medi-Cal

Family

Self Insurance

LTC Insurance

More Info

The Original Medicare program has two parts. Part A for institutional care, inpatient hospital care, skilled nursing home care, post-hospital home health care and hospice care. Part B for physician services, outpatient hospital care, physical therapy, ambulance trips and medical equipment. In the newer Medicare+Choice program, the HCFA has made contracts with a variety of fee-for-service and managed care organizations. Medicare beneficiaries must choose between the Original Medicare program and the Medicare+Choice program. A beneficiary cannot have both.

Does Medicare Pay for LTC?  
There is confusion in the minds of many about whether Medicare pays for LTC or not. It gets down to a matter of definition. Medicare pays for restorative care. It does not pay for custodial care. Restorative Care is skilled nursing care and rehabilitative services designed to make you better. For example, you have a stroke and you temporarily loose your ability to talk. Medicare may pay for your daily speech therapy that is needed to help you regain your ability to talk. Another example, you have a stroke and you permanently loose your ability get up out of bed and get yourself dressed. Medicare will not pay for someone to help you up and get dressed every day. This second example involves Custodial Care that Medicare will not pay for.

How About Medicare Supplements?
Medicare supplements are an extension of Medicare. They may help you pay your deductibles and coinsurance. But supplements will not pay for long-term custodial care.  

In Perspective
Don't count on Medicare to pay for your long-term care. Medicare involves providing you with temporary skilled nursing care and rehabilitative services to help you recover from an acute injury or sickness. LTC involves providing you with ongoing services that help you with the activities of your daily life when you are chronically ill and, in most cases, you won't be getting better. Your need for assistance will, most likely, increase over time.