Contrary to popular belief, Medicare does not pay for long-term care. Millions of Medicare enrollees must pay for long-term care services like personal assistance at home, assisted living, and nursing home care from their own pocket (savings).
People often misinterpret the coverage provided by Medicare’s “post-acute” home health care and skilled nursing facility benefits. Post-acute services focus on medically-related skilled nursing and therapy services some patients require following hospital or outpatient treatment. Skilled nursing visits for wound care and physical therapy are examples. Contrastingly, long-term care is comprised of personal assistance with routine activities like bathing, going to the bathroom, and managing medications, typically, for a period of three months or longer. Despite their distinct differences, because home health agencies and skilled nursing facilities offer both types of care, confusion is often the result.
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Medicare’s home health care benefits covers intermittent skilled nursing and therapy visits for those who are homebound and have a doctor-certified medical need for services. Those who argue that the home health benefit covers long-term care generally focuses on home health aide visits, which provide some personal assistance to those eligible for skilled visits. However, coverage of these visits is limited and data suggest that they are a small portion of the overall home health program. Only 17% of Medicare home health visits, accounting for roughly 11% of home health spending, are aide visits with the majority of these visits being allocated to people with temporary, not long-term needs for personal assistance.
Medicare will cover up to 100 days of skilled nursing facility care following a hospital stay of at least three days for those with a daily need for skilled care, like intravenous injections or physical therapy. Data indicates that majority of Medicare-financed skilled nursing facility stays are much shorter than they would be if providers maximized Medicare to pay for long-term care. Ninety percent of Medicare-covered skilled nursing facility stays are for a period of 60 days or less, with more than half (52%) being 20 or fewer days.
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It is imperative that Americans understand the limits of Medicare coverage when considering long-term care decisions. Also, policy leaders like the Commission on Long-Term Care, need to portray an accurate picture of how long-term care if financed. The Commission should clearly state that most Medicare enrollees, like most AMericans, have no insurance protection for long-term care.
Christopher J. Berry is an elder law lawyer in Michigan Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.theeldercarefirm.com/ or call 248.481.4000