Long Term Care is a range of services and supports you may need to meet your personal care needs. Most Long term care is not medical care, but rather assistance with the basic personal tasks of everyday life, sometimes referred to as “Activities of Daily Living” or ADLs. Some examples are:
-Using the toilet
-Transferring (to or from bed or chair)
-Caring for incontinence
Other Long Term care services and supports are assistance with everyday tasks, sometimes called “Instrumental Activities of Daily Living OR IADLs, Some examples are :
-Preparing and cleaning up after meals
-Shopping for groceries or clothes
-Using the telephone or other communication devices
-Caring for pets
-Responding to emergency alerts such as fire alarms.
Just beginning to think about long term care?
Think about who needs the care?
How much care will this person need?
Who will provide the care?
Where can they receive the care?
Who pays for the care?
What is covered by Medicare?
Medicare only covers medically necessary care and focuses on medical acute care, such as doctor visits, drugs and hospital stays. Medicare coverage focuses on short-tern services for conditions that are expected to improve, such as physical therapy to help you regain your function after a stroke.
Medicare pays for health care for people age 65 years and older, people under age 65 with certain disabilities and people of all ages with end-stage renal disease (permanent kidney failure that requires dialysis or a kidney transplant).
Long Term Care Services – Skilled Nursing
Medicare does not pay the largest part of long-term care services or personal care – such as help with bathing or supervision often called custodial care. Medicare will help pay for a short stay in a skilled nursing facility, for hospice care, or for home health care if you meet the following conditions:
-You have had a recent prior hospital stay of at least three days.
-You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay.
-You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy.
If you meet all these conditions, Medicare will pay for some of your costs for a hospital stay from days 21 through 100, you pay your own expenses up to $157.50 per day as of 2017, and Medicare pays the balance. You pay 100 percent of the costs for each day you stay in a skilled nursing facility after 100 days.
Long Term Care Services – Home and other Care Services
In addition to skilled nursing facility services, Medicare pays for the following services for a limited time when your doctor says they are medically necessary to treat an illness or injury:
- Part-time or intermittent skilled nursing care
- Physical therapy, occupational therapy, and speech-language pathology that your doctor orders that a Medicare-certified home health agency provides for a limited number of days only
- Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease, medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, you pay 20 percent of the Medicare-approved amount
There is no limit on how long you can receive any of these services as long as they remain medically necessary and your doctor reorders them every 60 days.
Medicare covers hospice care if you have a terminal illness and are not expected to live more than six months. If you qualify for hospice services, Medicare covers drugs to control symptoms of the illness and pain relief, medical and support services from a Medicare-approved hospice provider and other services that Medicare does not otherwise cover, such as grief counseling. You may receive hospice care in your home, in a nursing home (if that is where you live), or in a hospice care facility. Medicare also pays for some short-term hospital stays and inpatient caregiver respite.
Finally, the long-term care market has changed over the last few years mainly due to a low-interest rate environment. Many insurance companies have severely limited the benefit period of providing long-term care benefits. In an effort to continue to provide this valuable coverage to individuals and find an acceptable balance between risk and reward for the companies, several companies have added long term care or a critical illness rider (sometimes at no additional charge) to their permanent life insurance products offered. This can prove valuable to the insureds, as some will be able to receive coverage that would not qualify for long-term care. Others feel as though it is not a “use it or lose it proposition” as many long-term care policies are today. They now have the option to use the cash values (if it is a cash value policy), for long term care/critical illness, or provide for their family or charitable organization as part of their overall estate/legacy plan passing along tax-free dollars at death.
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