We continue our “Medicare Doesn’t Cover That” series with Long-Term Care. Most long-term care services aren’t covered by Medicare, but skilled nursing care services can be. So what’s the difference?
Long-Term Care
Long-term care is a variety of services provided to those with a chronic illness, injury, or naturally declining health. Long-term care services are usually for personal care needs and normal “Activities of Daily Living” (ADLs), including eating, bathing, dressing, toileting, transferring, and continence. This type of care is commonly considered “custodial” care, not medical care, so Medicare doesn’t cover it.
However, there are some situations where Medicare Part A (hospital) will cover the cost of long-term care in a Long-Term Care Hospital (LTCH). This is typically when a Medicare beneficiary has been an inpatient in a hospital for 25 or more days and is transferred to a long-term care hospital facility that still incorporates some medical care as well.
Skilled Nursing Care
Skilled Nursing Facility Care (SNF) covers skilled care (think: rehabilitation) for a limited period of time, after a qualifying inpatient hospital stay (3 full days on the Original Medicare side). If you have a Medicare Advantage plan (Part C), a qualifying inpatient hospital stay might not be required in order to get approved for the skilled nursing facility care. Confirm this in your plan’s Evidence of Coverage (EOC).
You can potentially receive up to 100 days of skilled nursing facility care for each benefit period.
NOTE: Medicare Advantage plans are notorious for denying skilled nursing care from the start or not covering it for very long. Just know the skilled care coverage will most likely only be approved for a short time (maybe even only a few weeks).
Bottom line
Most long-term care services are NOT covered by Medicare.
Reference Links
www.medicare.gov
Long-Term Care
Long-Term Care Hospital Services (LTCH)
Skilled Nursing Facility Care
Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.
