There are a few government programs, including Medicare and Medicaid, that can help pay for long-term care services. Each program has certain regulations concerning which services are covered, your eligibility for benefits, the length of time you can receive benefits, and your out-of-pocket costs. In order to prepare for your long-term care needs, you should be aware of the facts regarding your coverage, and keep informed about any changes within each program.
Medicare only covers care that is medically necessary, including medical acute care, such as visits to the doctor, medications and time spent in the hospital. In addition, Medicare covers short-term services for ailments that are predicted to improve, including physical therapy.
In order to become eligible for Medicare, you must be age 65 or older, under age 65 with certain disabilities, or any age and have end-stage renal disease, which is permanent kidney failure that has to be treated with dialysis or a kidney transplant.
Medicare does not pay for the most significant aspect of long-term care services or personal care, including assistance with bathing, or for supervision that is frequently referred to as custodial care. Medicare covers the cost of a brief stay in a skilled nursing facility, hospice care, or home health care if you meet certain conditions:
You have recently stayed in a hospital for a minimum of three days;
Within 30 days of your time previously spent in a hospital, you were admitted to a nursing facility that is certified by Medicare;
You require skilled care, including skilled nursing services, physical therapy or other kinds of therapy.
If you meet each of these conditions, Medicare will pay for some of the expenses for a maximum of 100 days. For the initial 20 days, Medicare pays 100 percent of your expenses. Then you are responsible for your expenses up to $140 per day, as of 2013. Medicare pays any remaining balance. After day 100, you are responsible for the entire cost of each day spent in a skilled nursing facility.
Medicare also pays for specific long-term care services for a certain period of time if your physician states that they are medically needed to treat an illness or injury. If you suffer from a terminal illness, and it is anticipated that you will not live more than six months, Medicare will pay for hospice care.
Medicaid is a joint federal and state government program that assists low-income people with the payment of part, or all, of their health care expenses. It covers medical care, including visits to the doctor, and the cost of hospital stays. It also covers long-term care services in nursing homes, as well as those given at home, including visiting nurses and help with personal care. Medicaid differs from Medicare in that it covers the cost of custodial care in nursing homes and at home.
In order to become eligible for Medicaid, you must meet certain qualifications, including having earnings and assets that are not greater than the levels used by your state. Under federal law, if Medicaid pays for your long-term care services, that state must recover the amount that Medicaid expended on your behalf from your estate after your death. This is called Medicaid Estate Recovery.