No, Medicare will not cover long-term care services. If you require medical services while you receive long term care, Medicare will pay for necessary covered services. The custodial care that most people refer to when they speak of long term care is not covered by Medicare.
Custodial Care
Custodial care, also called long term care, is a set of services meant to help people with the functions essential to daily life. Fittingly, these are called the activities of daily living, or ADLs.
The activities of daily living are personal care services. These include getting in and out of bed or a chair, showering, dressing, using the toilet, eating, and walking around. People are deemed to have a limitation in one of those activities when they cannot easily perform the activity by themselves, or have difficulty without using special equipment, or they cannot perform the activity because of a health problem. Difficulty with three or more of these ADLs is usually the reason why people transition to long term care or begin receiving home health services.
These custodial care services are not medical services and do not need to be performed by a licensed health care provider.
Long term care services are what many people receive in a nursing home or other living facility. These are not quickly treatable symptoms tied to a specific diagnosis, and are ongoing. Medicare offers no coverage for long term care, so you pay 100% out of pocket for these services.
Skilled Nursing Facility Care
While receiving skilled medical care at a skilled nursing facility, a person may receive minimal custodial care services. Likewise, while staying in a long term care facility, a person may encounter an illness, injury or other condition that requires skilled medical care. Medicare will pay for those professional health care services.
Sometimes patients can get an infection or develop another condition while they are being treated for the diagnosed ailment. Medicare will pay for the care for that secondary condition.
Paying For Long Term Care
What do you do when you need long term care but Medicare will not cover it? Insurance, savings, retirement plans and Medicaid can help you afford your care.
If you plan ahead, you can purchase a long term care rider with your life insurance policy, or even a standalone long term care insurance policy. These insurance policies will usually pay a set amount per day toward your care. Read closely to learn more of the fine details of specific policies.
Some people are able to save money or have assets that they can liquidize to help pay for their long term care. This is a common story, of people selling their homes to move into a care facility. If savings are not in the cards, sometimes investments will help people afford their care. Annuities are one option for people who did not invest early in life but want to have a monthly payment coming in.
Finally, Medicaid is a need for those with long term care who have limited income and resources. Thankfully, unless Medicare, Medicaid pays for long term care. Often, people will spend enough toward their care that they qualify for Medicaid and can start receiving coverage.
