Medicare and Long-Term Care

Long-term Care Options For Your Personal Care Needs

Medicare and Long-Term Care

By Evan Tunis

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How does Medicare and long-Term care work together? Are they related?

As we age, the likelihood of needing long-term care increases. According to the Department of Health and Human Services, about 70% of people over the age of 65 will require some form of long-term care during their lifetime. However, many people are unaware of the costs and coverage options for long-term care. 

Medicare is a federal health insurance program that provides coverage for eligible individuals over the age of 65, as well as those with certain disabilities and chronic conditions.

While Medicare provides coverage for many healthcare services, it does not cover long-term care in its entirety.

In this blog, we will discuss Medicare and its coverage for long-term care, as well as Medicare Advantage plans, skilled nursing facilities, and Medicare supplement insurance.

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Medicare and Long Term Care Coverage

Medicare is divided into four parts: Part A Hospital Insurance, Part B, Part C (Medicare Advantage), and Part D. Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. However, Medicare Part A only covers skilled nursing facility care for up to 100 days per benefit period, and only after a qualifying hospital stay.

After the first 20 days, there is a daily coinsurance amount that the patient is responsible for paying. Once the 100 days have been used, the patient is responsible for all costs of care.

Medicare Part B covers doctor visits, outpatient services, preventive care, and some medical equipment and medical services. While Medicare Part B covers some forms of home health care, it does not cover long-term care. 

However, Medicare Part B covers some types of therapy, such as physical therapy, occupational therapy, and speech-language pathology services, which can be important for those in need of long-term care.

Medicare Advantage Plans

Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies that have been approved by Medicare. These plans provide all of the benefits/Medical Services of Medicare Parts A and B, and often include additional benefits such as dental, vision, and hearing services. Some Medicare Advantage plans also provide coverage for prescription drugs.

Additionally, some Medicare Advantage plans may offer coverage for long-term care services not covered by traditional Medicare, such as in-home care or adult day care services. Most however do not cover personal care services.

It is important to note that not all Medicare Advantage plans provide long-term care coverage. When selecting a Medicare Advantage plan, it is important to review the plan’s coverage and cost-sharing requirements . Some plans may require copayments or coinsurance for long-term care services.

Skilled Nursing Facilities

Skilled nursing facilities (SNFs) provide 24-hour nursing care for patients who require ongoing medical attention or rehabilitation services. SNFs provide a range of services, including physical therapy, occupational therapy, and speech therapy. Medicare covers up to 100 days of skilled nursing per benefit period, as long as the patient meets certain criteria.

In order to qualify for this medical care, the patient must have a qualifying hospital stay of at least three days, and require skilled nursing care on a daily basis. Additionally, the patient must have a medical care plan that is reviewed and updated regularly by a doctor or other healthcare provider. If the patient does not meet these criteria, Medicare will not cover the cost of a skilled nursing facility.

Medicare Supplement Insurance

Medicare supplement insurance, also known as Medigap Plan, is sold by private insurance companies to help cover some of the out-of-pocket costs associated with traditional Medicare. Medigap policies are designed to cover some or all of the costs of Medicare deductibles, copayments, and coinsurance.

However, Medigap policies do not cover supplemental healthcare benefits such as Long Term Care.

Custodial Care and Medicare

Custodial care is non-medical care that is provided to individuals who require assistance with daily living activities, such as bathing, dressing, and eating. While custodial care can be an important service for many individuals, Medicare does not provide coverage for this type of care.

Instead, Medicare provides coverage for medical care, including hospital stays, doctor visits, and prescription drugs. For individuals who require custodial care, the costs of this care may need to be paid for out of pocket or through other insurance products, such as long-term care insurance. It is important for individuals to understand the limitations of their Medicare coverage and to plan for the possibility of needing custodial care in the future, as the costs of this care can be significant.

It is important to note that Medigap policies are only available to individuals who have both Medicare Parts A and B. Additionally, Medigap policies do not cover prescription drugs, so those who wish to have prescription drug coverage must enroll in a Medicare Part D plan.

About Long Term Care Insurance

Long-term care insurance is designed to cover the costs of long-term care services, including home health care, assisted living facilities, and nursing homes.

Long-term care insurance policies vary in their coverage, but most provide coverage for a range of services, including custodial care, skilled nursing care, and personal care. Long-term care insurance can be purchased from a variety of insurance companies, and the cost of the policy will depend on factors such as the individual’s age, health status, and the level of coverage desired.

While long-term care insurance can be expensive, it can be a valuable investment for those who are concerned about the costs of long-term care. Without long-term care insurance, individuals may be forced to pay for long-term care out of pocket, which can be financially devastating. Additionally, long-term care insurance can provide peace of mind, knowing that if long-term care is needed, there is a plan in place to cover the costs.

Statistics about Long Term Care

Long-term care can be tremendously expensive, and unfortunately, your options for covering it are limited. We can offer you long-term care insurance that covers and gives benefits that Medicare doesn’t. Long-term care will cover an individual for a myriad of events like: 

  • Skilled nursing facility past 100 days 
  • Home Health Care (average person will need LTC for 3 to 5 years)
  • Nursing Home Stay (average person will need LTC for 2.4 years)
  • Assisted Living Facility (average person will need LTC for 2.5 to 3 years)


We recommend you purchase a long-term policy earlier in your life, because the premium increases as you age, so purchasing early makes the policy more affordable. Questions on Long-term Care? Give us a call today!


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