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LONG
TERM CARE - MEDICARE
Medicare
is often thought to pay for all long term care. This is an expensive
mistake people make. Medicare only pays for certain types of long
term care and not for very long.
Medicare
pays for a small fraction of long term care because about 90% of
long term care is custodial care or unskilled care. Medicare will
only cover up to 100 days for skilled care and the patient
must be getting better to receive benefits. Therefore, you can not
rely on Medicare for paying your long term care expense if it is
not skilled care!
- Medicare
only pays for long term care if the care you receive is skilled
care.
- If
you are receiving skilled care, Medicare will pay a maximum of
100 days and you must be getting better to receive the benefits.
- Approximately
90% of long term care received is solely custodial or non-skilled
care and Medicare will not pay for this care.
For example: Betty had
a stroke during an operation. She lost some of her ability to use
her left arm and can not walk without assistance. Betty can no longer
dress herself, cook or bathe. She is place into a rehabilitation
and Medicare pays for her care, for a period of time, as long as
she is getting better.
 Betty
can now walk on her own, but can not dress herself, nor bathe herself.
She lives with her son but, he can not care for her full time. As
time goes on, Betty's legs get weaker and she can no longer walk
without assistance. She needs help walking, bathing and going to
the bathroom since she can not walk independently. This is too much
for her son and she is sadly sent to a nursing home. The nursing
home admits her and puts her into physical therapy to help her walk.
Medicare pays for her
skilled nursing home stay for approximately 43 days because she
was receiving skilled care and was improving for those 43 days.
However, after 43 days, she is no longer improving and therefore,
no longer needs skilled care. Although she had therapy, she still
can not walk on her own and continues to need full time custodial
care (help dressing, bathing and walking). Medicare will no longer
pay for her nursing home stay. She must pay for nursing home care
herself. Once her assets are depleted, she must rely on Medicaid.
If Betty had long term
care insurance, it could pay for her to have unskilled care at home
while her son was at work. However, without insurance, she is forced
to go to a nursing home.
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