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Will your medicare cover long term care costs?

Medicare helps many seniors pay for their medical expenses. But does Medicare cover long-term care costs? Before you reach retirement, it’s important to understand what costs you’ll be responsible for. Read on to discover what long-term care costs Medicare will cover. We will also outline options to help you pay for the costs that Medicare won’t cover.

Long-Term Care Explained

Long-term care consists of numerous services that help individuals meet their care needs. For those with a chronic condition or disability, long-term care provides medical and non-medical support. Long-term care services can include help with daily tasks such as bathing, eating, or dressing. Other long-term care services may include housekeeping, meal preparation, transportation to doctor’s appointments, and assisting with basic communication.

Individuals may receive long-term care in their home, an assisted living facility, or a nursing home.

Medicare Long Term Care Coverage

Will your medicare cover long term care costs?

While Medicare doesn’t cover the majority of long-term care costs, there are some expenses that Medicare will pay for. One expense that Medicare long term care may cover is a short stay in a skilled nursing facility. As long as you meet certain requirements, Medicare long term care will cover the costs. These requirements include:

  • You had an inpatient hospitalization admission for at least three days.
  • You checked into a Medicare-certified nursing facility within 30 days of your inpatient hospital stay.
  • If you need skilled care such as professional nursing services, physical therapy, or other types of therapy.

Medicare long term care may pay for the first 20 days in a skilled nursing facility. After that, you’ll need to pay $170.50 of coinsurance per day, for up to 100 days. Once you surpass 100 days, you’re responsible for the cost of your care.

Another cost Medicare may cover is short-term skilled nursing care due to an illness. If a medical professional states you need to receive care in your home, Medicare may pay in-home care from nurses and therapists. Medicare may also provide services to help you maintain your life at home. Typically, Medicare limits your care to 28 hours per week. But, with your doctor’s recommendation, you may qualify for additional attention.

Additionally, Medicare long term care may cover hospice care costs. If you have a terminal illness and are in your last stage of life, hospice care is available to keep you comfortable. You may qualify if you have a terminal illness and your doctor determines you will not live another six months. If you need care beyond six months, your doctor will need to certify you are still terminally ill to enable you to qualify for additional benefits.

What Costs Are Not Covered By Medicare

Medicare enrollees who need to stay in a nursing facility past 100 days must use private insurance or another form of payment to cover the cost. Additionally, Medicare enrollees will need to cover costs for adult day care, Alzheimer’s and dementia care, custodial care in an assisted living facility, and care that doesn’t meet the requirements above.

It’s important to verify what Medicare will cover before receiving services or committing to a care plan.

Alternatives to Long-Term Care Coverage 

Will your medicare cover long term care costs?

According to the U.S. Department of Health and Human Services, a private nursing home room can cost $253 a day or $7,698 per month on average. If you don’t have adequate savings, these costs could be a huge financial burden. With Medicare only covering your short-term care needs, you may need alternative financial support.

One option is to buy long-term care insurance. Typically, you can buy long-term care insurance from many different private insurance companies. The type of expenses your policy covers will depend on the type of policy you invest in. Usually, long-term care insurance covers expenses that are not covered by Medicare or traditional health insurance.

These costs can include staying in a nursing home or assisted living facility. Other services that may qualify for coverage under a long-term care policy include skilled nursing care and physical, occupational or speech therapy. Before you buy a policy, make sure you understand what’s covered so you can tailor your coverage to suit your needs.

You also may qualify for Medicaid. This is an option for individuals with lower household income and asset levels. Medicaid may cover some of your long-term care costs. Typically, if you have Medicaid and Medicare most of your long-term care expenses will qualify for coverage. Keep in mind, Medicaid qualifications may vary from state to state.

If your assets are too high you will not qualify for Medicaid. This means you may need to exhaust your financial resources before you will become eligible.

Bottom Line

While many seniors may assume Medicare covers all medical and care expenses, this is not the case. Understanding your benefits will help you prepare for your coverage needs.

Comparing your long-term care coverage options will ensure you receive the financial assistance you need.

Retirement tips

  • If you’re still wondering what role Medicare long term care will play in your retirement, a financial advisor may be able to help you figure it out. Finding the right financial advisor that fits your needs doesn’t have to be hard. SmartAsset’s free tool matches you with financial advisors in your area in 5 minutes. If you’re ready to be matched with local advisors that will help you achieve your financial goals, get started now.
  • Ensuring you have adequate healthcare and long-term care coverage is just one aspect of getting retirement ready. As you prepare for a comfortable retirement, SmartAsset’s retirement guide can show you how much you’ll need to save, how much risk you’re willing to take, and how big a bite taxes and inflation will take from your earnings.

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Ashley Kilroy Ashley Chorpenning is an experienced financial writer currently serving as an investment and insurance expert at SmartAsset. In addition to being a contributing writer at SmartAsset, she writes for solo entrepreneurs as well as for Fortune 500 companies. Ashley is a finance graduate of the University of Cincinnati. When she isn’t helping people understand their finances, you may find Ashley cage diving with great whites or on safari in South Africa.
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