Does Medicare Ever Pay Your Long Term Care Costs - Yes and No

Medicare generally will not pay for the cost of long term care (LTC) because Medicare pays for only medical help - not nonskilled living assistance care which is what LTC refers to. But often a situation of LTC occurs in conjunction with a medical problem. Then Medicare will pay - but only for a short term. Here's the scoop...

The Medicare program that Americans rely on after they turn 65 provides for a variety of medical treatments. These include hospital, physician, skilled nursing costs and some drug prescription costs. It's a complicated program.

Long term care (LTC) generally refers to the nonmedical skilled (called unskilled or custodial) care that older people need when they can't perform - or need help with - some of their activities of daily living (ADLs). This help is not considered medical help - and that's why Medicare doesn't cover it when there's no overriding medical issue. So Medicare doesn't cover typical LTC costs.

*When Medicare covers short term LTC:

Often, a person may suffer a medical problem that then leads him into a circumstance where typical LTC is required - perhaps in a nursing home. In this 'medical care to LTC transition' some Medicare assistance is available. Here's the circumstance.

For Medicare to help you with LTC costs, three criteria must be met:

1. You have a medical necessity,

2. The 72 hour rule, and

3. A Place where care can be given The medical necessity means that your care must result from a condition for which you were hospitalized. It must be medically necessary and given by skilled personnel in a place such as a nursing home.

Your hospitalization must have lasted for a full 72 hours. That means 3 days and 3 nights.

A place where care can be given means that you were taken from your hospitalization directly to a nursing home where you can receive skilled care related to your hospitalization. That's because Medicare pays for medically necessary skilled care in a nursing home setting.

*How long will Medicare Pay for you in a nursing home

If you meet the above criteria, Medicare may perhaps pay up to 100% of your costs in a nursing home for the first 20 days in a benefit period. To go beyond that 20 days, you'll be required to pay a co-insurance amount from day 21 through 100.

Two further exceptions to the Medicare's limited nursing home care exist. Medicare can pay a skilled caregiver to come to your home if it's a medical necessity and you're homebound. Also end-of-life or hospice care can be covered. You'll have to check what your state specifically allows for costs, though.


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