Does Medicare Cover Long-Term Care?

• by Christian Worstell
• December 9, 2021

Some Medicare Advantage plans may cover certain long-term care and at-home care services, such as home-delivered meals, grab bars for home bathrooms and other additional benefits.

Learn more about your Medicare coverage options, and find out how to find the long-term care benefits you need.

Medicare Advantage plans cover hospice and some home health care services

Medicare Advantage plans (Medicare Part C) replace your Medicare Part A and Part B benefits with a private insurance plan. Every Part C plan must provide the same hospital and medical benefits as Original Medicare (Part A and Part B).

This means that Medicare Advantage plans cover the same specialized care that is outlined below. The only exception is hospice care, which you will still receive through your Medicare Part A benefits.

Many Medicare Advantage plans also cover prescription drugs, and some plans may also provide coverage for:

• Dental care
• Vision care
• Hearing care

Although Original Medicare does not cover long-term custodial care (including nursing home care), Medicare Part A and Part B may help cover other specialized types of care for limited periods of time:

• Care in a long-term care hospital*
• Skilled nursing care in a skilled nursing facility
• Eligible home health services
• Hospice and respite care

Learn more about these aspects of Medicare coverage.

*Long-term care hospitals do not provide long-term custodial care, despite the name. Long-term care hospitals focus on patients who require longer hospitalizations related to serious illnesses or conditions.

Medicare Part A covers services received in long-term care hospitals (LTCH)

Medicare Part A provides hospital insurance and covers care received in a long-term care hospital (LTCH). You may qualify for this type of care if you meet the following two requirements:

• You have more than one serious health condition
• You may improve with care and time, eventually being able to return home

You generally must meet your Part A deductible for each benefit period during which you are admitted for an inpatient stay at an LTCH. The 2022 Medicare Part A deductible is $1,556 per benefit period.

After you meet the Part A deductible, you are responsible for Part A coinsurance payments of $389 per day (in 2022) for days 61-90 of your inpatient stay in each benefit period, and $778 per day for days 91 and beyond in each benefit period until you exhaust your 60 lifetime reserve days.

When your 60 lifetime reserve days are used up, you are responsible for all costs.

Medicare Part A covers care in a skilled nursing facility (SNF)

Medicare Part A covers services you receive in a skilled nursing facility (SNF) that can include meals, physical therapy, medical supplies, a shared semi-private room and more for a limited period of time.

You may be eligible for care in an SNF if you meet all of the following conditions:

• There are days left in your Part A benefit period
• You experience a qualifying hospital stay
• A doctor decides you need daily skilled care from skilled nursing or therapy staff
• Your SNF is certified by Medicare
• You need this care for a hospital-related health condition or a condition that started while you were in an SNF for a hospital-related condition

You will also need to meet your Part A deductible for each benefit period before Medicare Part A begins paying for your SNF care.

Your Part A coinsurance in 2022 is $194.50 per day for days 21-100 of your stay, and you pay all costs for days 101 and beyond.

Medicare Part A and/or Part B cover some home health services

Medicare Part A and Part B medical insurance cover some home health services, such as:

• Part-time or intermittent skilled nursing care
• Part-time or intermittent home health care services
• Physical or occupational therapy
• Speech-language pathology services
• Medical social services

Medicare Part A and Part B will not cover the following home health services:

• Meal delivery
• Custodial care or 24-hour-a-day care
• Homemaker services

You  may qualify for these Medicare-covered services if you meet the following requirements:

• You are under the care of a doctor and receive care under a doctor’s care plan
• A doctor certifies that you need physical or occupational therapy or speech-language pathology services
• A doctor certifies that you are homebound

You typically have no Medicare costs for home health care services, and you typically pay 20 percent of the Medicare-approved amount for qualified durable medical equipment (DME) you may require while receiving home health care.

Check with your home health care agency to confirm how much Medicare will pay for your care.

Medicare Part A covers hospice care

Medicare Part A will cover hospice care you receive at home or in a hospice inpatient facility. Depending on your terminal condition or illness, Medicare will cover:

• Doctor and nursing care services
• Medical equipment
• Medical supplies
• Prescription drugs to help with symptom control or pain relief
• Physical or occupational therapy
• Social work services
• Speech-language pathology therapy
• Dietary counseling
• Short term respite care and inpatient care
• Grief counseling

Medicare Part A will cover your hospice care if you meet the following criteria:

• Your hospice doctor and your regular doctor certify that you’re terminally ill
• You accept palliative care for comfort rather than care intended to cure your illness
• You sign a statement stating that you choose hospice care

You typically do not pay for Medicare-covered hospice care.

You may need to pay up to $5 for each prescription drug you take for pain relief and symptom control. You may also need to pay 5 percent of the Medicare-approved amount for inpatient respite care.

Find a Medicare Advantage plan to help cover your care

A licensed insurance agent can help you compare Medicare Advantage plans in your area that cover the qualified long-term care you need. An agent can even help you enroll in a plan right over the phone.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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