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Medicare Insurance  

It is very important that you are aware of Medicare's limits. Medicare may be one of the most misunderstood government programs in defining what is actually covered for long term care services. Medicare is a Federal program administered by the Center for Medicare and Medicaid. It is available to most people at age 65 or those with end stage renal disease.

According to the pie charts shown above, you can see that Medicare paid only a small percentage of the nation's long term care bill. The reason that Medicare doesn't pay for more long term care is that most long term care is not skilled care and that is what Medicare primarily pays for. There are two parts to Medicare, Part A and Part B. As it relates to long term care, Medicare Part A will pay for skilled nursing care, home health care (very limited), and hospice.

Medicare Skilled Nursing Facilities
Relying on Medicare to pay for your long term care is not an adequate solution because it only has the potential to pay for up to 100 days in a skilled nursing facility. The requirement is that you have to be receiving skilled care on a daily basis at least five days a week and you have to have had a three-day hospital stay prior to entering the nursing home. Most people do not qualify for the entire 100 days because they don't meet Medicare's criteria. *There are additional criteria as well.

Medicare will pay for the first 20 days in full, and will pay for all costs except a co-pay in 2005 of $114.00 for the next 80 days. However, the average number of days paid by Medicare is only 23 days according to the Health Care Financing Administration, 1998.

It is important to point out that if you only needed custodial care you would not receive any Medicare benefits.

Medicare Home Health Care Benefits
Many people mistakenly think that Medicare will pay for an unlimited amount of home care. Medicare will not pay for full-time long term care. Medicare will only pay for a limited number of visits. The pie chart above shows you the percentages of the nation's long term care bill that covers home health care benefits. There are many requirements to get home health care benefits under Medicare. A few of them include that you must be homebound and must need skilled care for fewer than five days per week. In any case, Medicare generally does not adequately cover long term care.


For more information on Medicare you can call 1-800-Medicare (1-800-633-4227) to speak to a Medicare Customer Representative or visit www.medicare.gov/


Common Misconceptions
If Medicare doesn't pay, won't my Medicare Supplement pay for my long term care?
Generally, Medicare supplements only pay co-payments of Medicare. If Medicare will not pay for your care, then your Medicare supplement probably will not pay either.

I have an HMO, so doesn't that pay for my long term care?
Generally, HMO's offer the same benefits that Medicare offers. To encourage people to assign their Medicare benefits to an HMO, many HMO's offer additional ancillary benefits like vision and prescription benefits. However, they generally use the same criteria that Medicare does when it comes to paying for long term care services.

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