By Lisa Rademakers
THE ERICKSON TRIBUNE
You may not realize it, but 60% of Americans who reach age 65 will need long-term care at some point in their lives. Today, the average cost for long-term care is more than $70,000 a year (in a Medicarecertified nursing home). Do you know who pays for this care?
“There is a lot of misunderstanding about who pays for longterm care,” says Richard Johnson, principal research associate at the Urban Institute and a leading national expert on the health and income security of older Americans.
“Many people say they have long-term care insurance, but when you ask them what the source is, they say it’s Medicare.” This is alarming because Medicare does not pay for longterm care. Most health plans, including Medigap and Medicare Advantage plans, do not cover long-term care either.
What may be leading to this confusion is the fact that Medicare pays for certain “skilled nursing care.” Skilled nursing care is usually ordered by your doctor and involves rehabilitation therapy or specific medical care.
Medicare covers skilled care
In order to qualify for Medicare coverage of skilled care, Medicare requires that you be hospitalized for at least three days. After that, your doctor must prescribe “medically-necessary” treatment, such as intravenous injections or physical therapy.
For a short period of time— 20 days to be exact—Medicare covers the cost of such skilled care. For the next 80 days, Medicare covers some of the cost, and you pay some of the cost (more than $100 a day). When you reach the 101st day, you are responsible for all costs.
Medicare covers skilled care for medical treatment for a short time. In contrast, it does not pay for “custodial care,” or personal assistance with the activities of daily living (ADLs), for a long period of time. ADLs include eating, dressing, bathing, and other activities. Typically, this is the type of care people refer to as “long-term care.” If this is the only kind of care you need, Medicare does not pay for it.