What Does Medicare Cover for Long-Term Care? 

Planning ahead for medical expenses is smart, but you can’t always predict when a medical emergency will strike or when a serious medical condition will sideline you for a long period of time. Long-term care planning is crucial to stave off high costs and the potential burden long-term care needs might place on loved ones, but many seniors wonder whether having Medicare alone is enough. Does Medicare cover long-term care? If it does, what services does it cover?

What does Medicare cover for long-term care?

Before looking deeper into the subject, it’s first important to state plainly that Original Medicare does not cover long-term care. This means that if you require long-term care in a nursing facility, residential facility or hospital, you are responsible for the total cost.

With that out of the way, Medicare does cover medically necessary inpatient care on a temporary basis each benefit period. Understanding the limitations of your Medicare coverage is important because you will want to know when your benefits expire should you find yourself needing care in a hospital or skilled nursing facility.

The limits of Original Medicare coverage

Original Medicare includes coverage for inpatient care provided by a Medicare-participating hospital or skilled nursing facility. Medicare recipients receive this coverage through Medicare Part A, the inpatient benefit.

Under Part A coverage, you can receive 60 days of inpatient care in a hospital at no cost. You will, however, need to be current on your premium if you are required to carry one, and you will need to have met your deductible for the year before Part A coverage goes into effect.

After 60 days and through day 90 of an inpatient stay in a hospital, you can continue to receive coverage for your care, but these days will be covered at a discounted rate. For 2022, this rate is $389 per day. From day 91 onward, you can use any lifetime reserve days that you have saved up at a continued discounted rate. The discounted rate for lifetime reserve day usage in 2022 is $778 per day.

Skilled nursing facility coverage is similar, but the costs are slightly different. If you are admitted to a skilled nursing facility, your first 20 days are covered completely by your Part A benefits. From day 21 through day 100, you pay a discounted rate. For 2022, this rate is $194.50 per day. After day 100, you are responsible for all costs of continued care.

Long-term care at home

Because Original Medicare does not provide long-term care coverage, in-home care of this nature is not covered. Medicare benefits do, however, cover some home health services when medically necessary.

These services may include visits from a nursing service to administer medications via injection or to monitor health conditions. Services are usually covered by Medicare Part B, the outpatient benefit, but they may also include some costs covered by Medicare Part A, the inpatient benefit, when services are provided by nursing staff from a local hospital following an admittance.

Long-term care and Medicare Advantage plans

Medicare Advantage plans typically provide more benefits than Original Medicare plans, but they are required to offer the core coverage of Original Medicare Parts A and B at the very least. Because all Medicare Advantage plans are different, it’s impossible to say whether these plans provide any long-term care benefits, but you can find out details by contacting your plan directly.

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