Long-Term Care Insurance - Limitations of Medicare

Many individuals tend to overlook the need for long-term care insurance because they believe that Medicare will cover them should they need assistance. Well, they are not totally wrong- Medicare will cover up to 100 days of care broken down as follows:

For year 2007:
First 20 days- Medicare pays 100% (skilled nursing care facility)
Next 80 days- Medicare requires a copayment (the amount you must pay) of up to $124 per day.

Generally, Medicare doesn't pay for long-term care, since very few nursing home stays are actually covered by Medicare. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn't pay for this type of care called "custodial care". Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring.

In order to obtain Medicare coverage of a skilled nursing facility stay, the following five conditions must be met:

  • Your condition must require daily skilled care which, as a practical matter, can only be provided in a skilled nursing facility on an inpatient basis.
  • You must have been in a hospital at least three days in a row (not counting the day of discharge) before you are admitted to a certified skilled nursing facility.
  • You must be admitted to the facility within a short time (generally within 30 days) after you leave the hospital.
  • You must have received treatment in a hospital for the condition for which you are receiving skilled nursing care.
  • You must receive certification from a medical professional that you need skilled nursing care or skilled rehabilitation services on a daily basis
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