How To Pay For Long Term Care Services Even If You Have Medicare Coverage

medicare coverage

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There still seems to be a lot of doubt and uncertainty out there regarding the Medicare coverage when it comes to your Long Term Care needs.

Services such as personal care, homemaker services, assisted living, companion and respite seem to be what most seniors are in serious need of these days, yet these very services are covered by Medicare on a very limited basis if at all, or with very high co-payments.

Knowing the limits and instances where you can expand, expect, and when to flat out pay for these services as a better option to care is what I’d like to share with you today.

So let’s put those doubts and concerns to bed once and for all… shall we! 

Medicare

Medicare is public health insurance for those ages 65 and older. Medicare by itself pays for a very limited amount of long-term care services. It only covers up to 100 days of care in a nursing home (skilled nursing facility) after you have spent 3 days in the hospital and as long as you need skilled care such as nursing or physical, occupational or speech therapy.

In some cases Medicare will cover home health care, but eligibility requirements are tight, they typically approve coverage of only 4 to 10 hours a week of care (exceptions are rare!). Medicare will also pay for hospice care for people with terminal conditions.

Medicare will only approve payment for care in Medicare-certified skilled nursing facilities or through Medicare-certified home health or hospice agencies. Medicare will not pay for services in an ALF (assisted living facility) or independent living facility.

If you have a chronic illness or disability and need extensive long-term care services, for conditions such as Alzheimer’s Disease or Parkinson’s, you will need to find resources other than Medicare to help pay for these services.

Here’s a guide to these services and resources.

Medicare coverage will only extend to conditions with clear rehab potential, of an acute nature, and requiring specific skilled care services.

So for a quick recap!

If your Mom or Dad clearly need long term care services, and were recently discharged from the hospital to a Skilled Nursing Facility or Nursing home, make sure that the social worker assigned to your case tells you exactly the days you’ll have available for LTC and to start looking into the application process for community-based service (HCBS) Medicaid waiver programs available in your state.

In South Florida you can call The Alliance for Aging. Here’s a brief tutorial on how to apply for the Long Term Care program they will assess you for.

Don’t wait till your 90 days run out, they will… Start the process for a smooth transition and consider the possibility that there may be time gaps where you’ll need to cover some services out of pocket.

Untitled designClaudio Alegre is the CEO & Chief Content Writer for Angel Home Care Services on the Web and Patient and Family Advocate off the Web. He lives in Miami with his wife and 3 boys. He's passionate about healthcare and all things caregiving. He can be reached at [email protected] or directly at 305.220.4544
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