Seven out of ten people will eventually need long term care, and when that time comes nearly all will ask the question, “does Medicare cover long term care?” Unfortunately, Medicare does not cover long term care and only covers short term care in part.
It’s important that people plan to pay for in home care costs. Currently 44 million Americans, or 15% of the population, are covered by Medicare for their health insurance coverage. Medicare is the health insurance program run by the Federal government and is funded through payroll taxes. It’s primarily meant for people over 65, but people with certain health conditions may be eligible at a younger age.
What does Medicare Cover?
Medicare Part A includes hospital stays, hospice care, and limited time in a skilled nursing facility. Generally the patient is still responsible for some co-pays or deductibles.
Medicare Part B covers home health agency visits which are intermittent, short term, require a doctor’s order and “homebound status” of the patient, meaning the person must struggle to leave the home and go to a doctor’s office. Medicare generally does not cover companion or homemaker assistance and will not pay for daily or ongoing shifts.
Consider this scenario: An elderly person suffers a stroke and is hospitalized. After three days, she is discharged to a skilled nursing facility for physical therapy and occupational therapy. Under part A, Medicare will cover the full cost of her nursing facility stay for the first 20 days. For days 21 to 100, the patient must pay her own bill up to $176 per day, and then Medicare will pick up the balance. After 100 days, the patient is fully responsible for the entire cost of her remaining time in the skilled nursing facility. In California, as of the year 2020, a semi-private nursing facility room ran $9,247 monthly, while a private room costs $11,437 monthly.
If the patient decides to leave the nursing facility to go to her own home, where she lives alone, she may be eligible for home health visits under Medicare Part B. Her doctor will need to write an order, and then Medicare will fund visits by an RN, Physical Therapist, Occupational Therapist and Home Health Aide, depending on what the doctor requests. The visits will be less than 45 minutes, typically only two to three times per week and lasting only 30 to 60 days. Medicare funded home health is expected to be short term.
If the client needs more assistance with bathing, dressing, transferring, companionship, light housekeeping, running errands or with meal preparation, she’ll need to be prepared for paying for the in home care or rely on family to provide that ongoing long term care. The cost in California for professional in home care is roughly $31 hourly. and the average monthly cost for in home care is $5,529 based on 44 hours of care per week.
Given that many people are confused by what Medicare does and does not cover, more education and planning for long term care expenses are needed, and that planning needs to begin way before Americans reach age 65.
If Medicare doesn’t cover long term care, what options are there? Many people simply pay out of pocket, or use a combination of family helpers and hired caregivers to reduce the in home care costs.
Those with long term care insurance can file a claim for assistance with payments, and many veterans can access the VA Aid & Attendance Benefit. There are also ways to make the costs of in home care tax deductible.