What About Medicare?

Won't Medicare cover my long-term care needs?

The following criteria must be met in order for Medicare to pay for any of your long-term care bills.

-         You must have a hospital stay of three consecutive days (not counting the day of discharge)

-         You must be admitted to a nursing facility for the same illness you were hospitalized for within 30 days of discharge

-         Medicare covers only skilled care or rehabilitative care given in a certified skilled nursing facility or in your home. Custodial Care is not covered when that is the only kind of care you need.

-         You must be certified by a medical professional that you need skilled nursing or rehabilitative services daily

How Much Will Medicare Pay for a Nursing Facility in 2018?

-         Days 1-20: Medicare pays 100% per benefit period, provided that you are receiving daily skilled care.

-         Days 21-100: You pay the first $167.50 per day per benefit period, and Medicare will pay the balance.

-         Days 101+: Medicare pays nothing.

Who is Eligible for Medicare covered Home Health Care?
   To qualify, you must meet all of the following conditions

-         Your doctor must decide that you need care at home and create a plan of care.

-         You must need at least one of the following:

o        intermittent skilled nursing care,

o        physical therapy

o        speech-language therapy

o        occupational therapy.

-         You must be homebound, or normally unable to leave home unassisted.

-         The home health agency caring for you must be approved by the Medicare program (Medicare-certified). 

-        Home Health Care visits can only be on a part-time or intermittent basis. Medicare defines part-time or intermittent as skilled nursing or home health aide services combined to total less than 8 hours per day and 28 or fewer hours each week.

What Medicare will not cover for Home Health Care?

Medicare does not cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. To qualify, the home health aide services must be part of the home care for your illness or injury.

Medicare does not pay for:

-         24-hour a day care at home,

-         prescription drugs,

-         meals delivered to your home,

-         homemaker services like shopping, cleaning, and laundry and   personal care like bathing, using the toilet, or help in getting dressed given by home health aides when this is the only care you need

 

Source: Centers for Medicare and Medicaid Services, Medicare & You 2010, National Medicare Handbook - pages 120-121

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