Medicare

Medicare

A common misconception is that Medicare will pay for long-term care costs. However, Medicare generally will not cover long-term care except in certain, specific circumstances. Medicare distinguishes between medical care (which is generally covered) and what is referred to as “custodial care,” which generally is not covered. Custodial care includes assistance with bathing, eating, using the toilet, and mobility. This is the level of care equivalent to the type of care provided in a nursing facility.

Medicare will briefly cover the costs incurred while staying in a skilled nursing facility. First, a determination is required that the care you are receiving is “skilled care.” If so, Medicare will pay for those costs for up to 20 days, and then a co-payment will be required. Medicare will stop payment for all services after a 100 day stay at a skilled nursing facility. Also, Medicare may stop all payments if it is determined that the condition for which you need skilled care is no longer improving.

Medicare will not cover hospital expenses incurred beyond 150 days, skilled nursing costs beyond 100 days, and will not cover any custodial nursing home care or non-skilled home health care.

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