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Long Term Care Basics

Long Term Care in Depth

 

What Does Medicare / Medicaid Cover?

Most individuals make the assumption that Medicare, the health-care program for the elderly, or Medicaid, the government's program for the poor, will pay for all their long-term care needs. Not so. Here's a guide to what each plan covers.

 

M E D I C A R E

Nursing Homes

To Qualify:

You have been hospitalized 3 days prior to needing skilled-nursing care, and a doctor certifies that you need it.

Home Care

To Qualify:

You are homebound, under a doctor’s care, require skilled-nursing care, and require a part-time home-health-aide and medical services.


Hospice Care

To Qualify:

A doctor certifies that you have 6 months or less to live.
Coverage Includes:

• Semiprivate room.
• Nursing services (not private duty).
• Supplies and equipment, and medicine furnished by facility.
Coverage Includes:

• Physical or speech therapy.
• Home-health-aide services for bathing and dressing.
• Medical equipment.


Coverage Includes:

• Two 90-day periods of care followed by an unlimited number of 60-day periods.
What is Paid:

Skilled-nursing-facility expenses for 20 days. Then you are responsible for a co-payment (now $105 a day). The plan ceases payments after 100 days per benefit period. (A benefit period begins the first time you are hospitalized and ends only after you have been out of the hospital for 60 days.)


What is Paid:

All medical services. Skilled-nursing and home-health-aide services for no more than 8 hours per day, or a maximum of 28 hours a week. Eighty percent of medical equipment such as hospital beds and walkers.
What is Paid:

All expenses for nursing and medical services, supplies, counseling, and home-health and homemaker services in a Medicare-approved hospice. Drugs and bereavement costs. Five percent of the cost of outpatient drugs, up to $5 per presciption, may be charged.

M E D I C A I D

Nursing Homes

To Qualify:
You meet a state-determined poverty level and certain health-related criteria. Generally, you may keep only the house in which your spouse or dependent resides, the furniture, a car, a burial plot and funeral funds, and a small amount of cash, often $2,000.

Coverage Includes:
• Room, board, nursing care, and social activities in the nursing facility.


What is Paid:
Room, board, nursing care, and social activities.



As you can see, Medicare and Medicaid can provide some help but alone, they will not cover your total expenses if you require long term care.

 



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