MEDICARE BLOG

If you are of Medicare age or nearing retirement, assisted living and nursing care, commonly referred to as "long-term care" should be at the forefront of your future planning. A big challenge facing seniors is the lack of understanding of Medicare and its relationship with long-term care. So let's take deeper look at how Medicare impacts long-term care, and what measures you should take to protect yourself.

When looking at the basics of Medicare, Part A is the most relevant when it comes to assisted living. Assisted living facilities provide a combination of housing, personal care services, and healthcare tailored to individuals who need assistance with daily activities but do not require the intensive medical and nursing care provided in nursing homes. Unfortunately, Medicare does not cover the cost of residing (room and board) in an assisted living facility.

However, Medicare may cover specific healthcare services received while living in an assisted living facility, such as:

• Skilled nursing care or medical services provided by a doctor or other healthcare provider
• Physical, occupational, and speech therapy
• Limited home health care services under specific conditions

Medicare C (Advantage) plans purchased through a private insurance company can also provide additional services while living in assisted living. But, just like basic Medicare, it does not cover any costs from the assisted living facility itself.

Skilled Nursing Care is defined as care provided by licensed nurses under the supervision of a doctor. This is typically at a hospital, but can also happen in assisted living facilities. This type of care is reserved for individuals with significant health issues or disabilities requiring continuous medical attention.

Medicare Part A covers up to 100 days of skilled nursing facility (SNF) care per benefit period, under these conditions:

• The patient stays at a qualifying hospital for at least 3 days
• The patient is admitted to SNF within 30 days of the hospital stay
• The patient is prescribed skilled nursing care or therapy services

As for coverage, the first 20 days are fully covered by Medicare, while days 21 through 100 require a copayment from the patient. Beyond 100 days, Medicare does not cover the costs, and individuals must find alternative funding sources such as Medicaid, long-term care insurance, or out-of-pocket payments.

As outlined above, there are limitations to what Medicare covers for assisted/nursing care. So what happens when a patient/senior needs long-term care outside of Medicare coverage? Here are some options to consider:

• Medicaid: For those with limited income and assets, Medicaid can cover long-term care costs, including nursing home care. Long-term care coverage through Medicaid varies from state-to-state. Learn more about Michigan's Medicaid Long-Term Care benefits.

• Long-term Care Insurance: This type of insurance can provide coverage for assisted living and nursing home care. It is advisable to purchase this insurance before the need arises, as premiums are lower and approval is more likely.

• Personal Savings: Many individuals use personal savings, retirement funds, or reverse mortgages to cover the costs of long-term care.
  

In conclusion, Medicare shouldn't be your long-term solution for assisted living/nursing care. With so many uncertainties associated with growing old, and increasing health care costs, it's crucial that you be proactive when planning for long-term care. Make sure you consult with a Medicare expert that can clarify your coverage under basic Medicare and provide other options to supplement your long-term care expenses.

Tyrone Carr & Associates (TCA) is a licensed Medicare agency with 2 decades of experience helping people make the best Medicare and Insurance decisions. TCA is located in Brighton, Michigan, and licensed in 20 states.

For more information about our services, contact our office today.