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Some people develop an ailment or a medical condition that may require long-term care. While Original Medicare and Medicare Advantage plans provide coverage for short-term care at home or in a skilled nursing facility, long-term care may be a different story.
If you or a loved one need this type of care, a common question is, “does Medicare cover long term care?” In this article, we answer the question in clear, plain English. You will also find the average costs of long-term care and other helpful info.
Does Medicare Cover Long Term Care?
The short answer is no. In most cases, Medicare will not cover the cost of long-term care. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your long-term care.
Original Medicare (Medicare Part A and Part B) does not provide coverage for long-term care. That means you will have to pay 100 percent of the costs of your long-term care. Long-term care is also known as custodial care. Original Medicare does not consider long-term care medically necessary so it does not provide coverage.
Long-term care includes services and support that are personal rather than medical. These services may include helping in bathing, eating, dressing, using the bathroom, and other activities that accomplish daily needs.
However, Original Medicare may provide coverage for long-term care in the hospital. Coverage for long-term care hospitals is provided by Medicare Part A if:
- You have at least two or more serious medical condition
- There is a certainty that your condition/s will improve with care and time, and you will eventually return home
In order to receive coverage, you need to meet your Part A deductible for each benefit period while you are admitted to a long-term care hospital. After meeting the Medicare Part A deductible, you are responsible for coinsurance of $371 per day from days 61 to 90.
After passing 90 days, you still have lifetime reserve days. Using those reserve days, you will pay for coinsurance. Once you use up your lifetime reserve days, you will pay 100 percent of the costs of your stay in a long-term care hospital.
You may receive long-term care in both inpatient and outpatient facilities such as a skilled nursing facility, hospice, and even in your own home. Even though Original Medicare does not provide coverage for long-term care, they provide coverage for short-term care in the facilities mentioned above. Medicare Part A covers most of the facilities above as they are mostly inpatient facilities. In-home care is covered by both Medicare Part A and Part B.
Part C Coverage for Long Term Care
Just like with Original Medicare, Medicare Advantage plans (Medicare Part C) also do not provide coverage for long-term care.
How Much Does Long-Term Care Cost?
Long-term care will usually cost between $75 to $255 a day. This comes out to be between $1,600 to $8,800 per month. Costs will vary depending on the type of care you need, where you receive the care and where you live.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover a refraction exam?