Archive for December, 2014

Does Medicare Pay for Long Term Care?

December 16, 2014

I am asked the Medicare question all the time, most recently on 12/15/2014, the morning of this writing.  A variation: “Nursing Homes, Assisted Living & professional Home Care are all very expensive.  What is the name of the government program that covers these costs?”  The presumption is that somehow the government or someone other than the person needing care (or his/her family), pays for needed long term care services.  I am sorry dear readers, but a program, satisfactory to the person who needs long term care, to pay for this care other than from personal assets or long term care insurance, simply does not exist.

To answer the Medicare question here are excerpts from two government publications.

“Medicare doesn’t cover long-term care or custodial care.”  2015 Medicare & You, the official U.S. government Medicare handbook, page 39.

Under What’s NOT covered by (Medicare) Part A and Part B?  “Long-term care.”  2015 Medicare & You, the official U.S. government Medicare handbook, page 62.

“Medicare and most health insurance plans, including Medicare Supplement Insurance (Medigap) policies, don’t pay for this type of care, sometimes called ‘custodial care'”.  2015 Medicare & You, the official U.S. government Medicare handbook, page 63.

From www.Medicare.gov, the official U.S. Government Site for Medicare.  Under What’s not covered by Part A & Part B?: “Some of the items and services that Medicare doesn’t cover include: Long-term care (also called custodial care)”.

Is there anyone who still thinks Medicare pays for long term care?  Medicare does not pay for long term care!

 

What about that other government program whose name sounds a lot like Medicare?  Medicaid (the other program) does cover long term care.  However no matter how you slice it, Medicaid is a welfare program intended for people who are truly poor….more about that in a subsequent monthly eNewsletter.  To qualify for Medicaid long term care, you cannot have too much income or too much in assets.  Medicaid long term care is mostly provided in Medicaid nursing homes (technically known as skilled nursing facilities).  Given a choice, why may someone choose to not receive long term care services from Medicaid?

With Medicaid long term care, you get to spend your last days in an institutional setting while receiving a less than average level of care.  I acknowledge that some facilities provide the same level of care to both Medicaid and private pay patients.  These mostly non-profits are few and far between and have long waiting lists.  Here is the core problem: The funding that facilities receive from Medicaid to provide long term care is less than the average cost of providing that care.  So what does this imply about caregiver pay and staffing levels?  There is no requirement for any long term care facility to accept Medicaid patients.  That is why most of the nicer places accept only private pay or long term care insurance patients.

The bottom line:

  1. Medicare does not pay for long term care.

  2. Medicaid does, but it is a welfare program designed for poor people and generally provides a lower level of care with fewer choices.

 

Disclaimer: This eNewsletter and all links to other sources should not be construed as tax or legal advice because they are neither. Raymond Smith, The Long Term Care Specialist, does not give legal or tax advice. Consult your attorney or tax advisor for these matters.

 

© Raymond Smith, The Long Term Care Specialist, 2014