Medicare Coverage for Long Term Care

Can Medicare cover long term care expenses?  The answer is a qualified “yes.”  Generally speaking, Medicare Part A covers certain services provided in a skilled nursing facility under certain conditions for a limited timeframe.

Services:  Medicare-covered services generally include shared rooms, meals, skilled nursing care, some physical, speech, and occupational therapy, medical social services, medications, medical supplies and equipment used in the facility, some ambulance transportation, and dietary counseling.

Conditions:  Medicare coverage is extended only if the beneficiary meets the following conditions:

1. The beneficiary must have a three-day prior hospitalization, counting the date of admission but not counting the day of discharge.
2. The beneficiary must be admitted to a skilled nursing facility within 30 days after discharge from the hospital.
3. The beneficiary must receive skilled care at the skilled nursing facility.
4. The beneficiary must require skilled care on a daily basis for a condition that relates back to the prior hospitalization.
5. The services the beneficiary receives must be ones that can only be provided in a skilled nursing facility on an inpatient basis.

Limited Timeframe:  If the above conditions are met, Medicare will fully cover the first 20 days of skilled nursing facility care.  For days 21 – 100, the beneficiary is required to pay a daily coinsurance amount equal to a percentage of the applicable inpatient hospital deductible (generally $164.50 per day).  For days 101 and beyond, there is no remaining coverage.

The above concepts are discussed in a general fashion for educational purposes.  Individual situations can vary greatly and applicable rules can change.   If you have additional questions on public benefit coverage for long term care, it may be time to call the experts at Bender, Levi, Larson & Associates for a confidential consultation.