Does Medicare Cover Long-Term Care?

Last Updated : 10/06/20184 min read

If you or a loved one needs long-term care, you may be wondering what your options are and how to pay for it. According to the U.S. Department of Health and Human Services, almost two-thirds of the people who need long-term care in the United States are over age 65.

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Learn more about what Medicare pays for long-term care.

Why would I need long-term care?

According to the U.S. Department of Health and Human Services, the need for long-term care often follows a fall. Preventing falls may delay your need for long-term care. Learn more about how to prevent falling. Chronic conditions such as diabetes and high blood also make you more likely to need long-term care. Alzheimer’s and dementia are very common among seniors and may be another reason to need long-term care. According to the Alzheimer’s foundation, one in three seniors dies with Alzheimer’s or another dementia.

Where can I get long-term care?

You may be able to get long-term care at home or at a long-term care facility.

  • You may be able to continue living at home with the help of a home health aid. According to the US. Department of Health and Human Services (HHS) the national average cost for a home health aid in 2016 is $20.50 an hour.
  • Adult day care centers provide a safe environment to be social and engage in activities during the day while family caregivers are otherwise occupied. According to HHS, adult day health care centers costs on average $68 per day.

Residential care includes:

  • Retirement housing that may offer social activities and transportation
  • Assisted living that offers meals, supportive services and health care. According to HHS, a one-bedroom unit in an assisted living facility costs on average $3,268 per month in 2016.
  • Nursing homes (also called skilled nursing facilities) which can provide 24-hour care and medical treatment. According to HHS, a private room in a nursing home costs on average $7,698 per month in 2016.
  • Memory care units for Alzheimer’s and dementia patients which may be locked.
  • Continuing care retirement communities were residents can progress through levels of care as the need arises.

Does Medicare pay for long-term care?

Original Medicare (Part A and Part B) covers some hospital and medical costs. Medicare Part D covers some prescription drugs. Medicare generally doesn’t cover long-term care except in certain circumstances. Medicare draws a line between medical care (which is generally covered) and what it calls “custodial care” which is generally not covered. Custodial care includes help bathing, eating, going to the bathroom, and moving around. However, Medicare may cover long-term care that you receive in:

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  • A long-term care hospital (generally you won’t pay more than you would pay for care in an acute care hospital)
  • Skilled nursing facility (Medicare covered services include a semi-private room, meals, skilled nursing care and medications)
  • Eligible home health services such as physical therapy and speech-language pathology
  • Hospice care including nursing care, prescription drugs, hospice aid and homemaker services

Although Medicare covers long-term hospital care, you could face significant charges if you receive long-term care beyond three months. In 2018 under Medicare Part A, you only have $0 coinsurance for the first 60 days of each benefit period. For days 61-90 you pay $335 per day of each benefit period. For days 91 and beyond you pay $670 coinsurance per each “lifetime reserve day” after day 90 for each benefit period and you only have up to 60 days over your lifetime. Beyond the lifetime reserve days you pay all costs until a new benefit period begins.

Do you have more questions about Medicare coverage?

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Benefits, and/or copayments/co-insurance may change on January 1 of each year.

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