Medicare coverage of skilled nursing facility care 2022

It’s essential to plan ahead for long-term care. What will happen if you can no longer take care of yourself? Who will help you get the care you need? These are difficult questions to answer, but they are important ones to think about. In this guide, we will discuss Medicare and long-term care. We’ll cover everything from what Medicare covers to how to pay for long-term care. We’ll also offer some advice on how to plan for the future. So, whether you’re just starting to think about long-term care or you’re already in the process of planning, this guide is for you!

Medicare Doesn’t Really Pay For Long-Term Care

Many people believe that Medicare covers long-term care. The fact is that Medicare pays for “short-term care” and does not pay for long-term care. Medicare was created to cover medical expenditures for acute diseases and illnesses. Once the beneficiary no longer requires a bed in an acute care facility, insurance coverage ends, and the beneficiary is on their own.

To qualify for this type of short-term Medicare coverage, the following is required:

• The individual must have been a hospital inpatient for at least three days.
• Within 30 days of leaving the hospital, the individual must be admitted to a skilled care facility.
• A doctor must certify that skilled care is required.
• A Medicare-certified facility must provide the services or care.

Medicare does not cover personal care services and custodial care provided outside a nursing home. However, suppose an individual qualifies for coverage based on the need for skilled nursing or rehabilitation. In that case, Medicare will pay for all of their needs in the facility, including assistance with activities of daily living.

Does Medicare Pay For A Skilled Nursing Facility?

Medicare does not cover the total amount of time in a skilled nursing facility beyond what is required by its regulations. Medicare covers SNF care as follows:

• On days 1 through 20, Medicare will cover 100% of the approved cost.
• The beneficiary must pay a daily co-payment on days 21 through 100, while Medicare covers the rest.
• Medicare pays nothing beyond Day 101.

Days 21 Through 100: Co-payments

When Medicare coverage requires a daily co-payment, the additional coverage might cover part or all of the beneficiary’s portion of the SNF cost for days 21 through 100. When the underlying Medicare benefit terminates, so does the supplemental coverage.

After Day 100: You Are On Your Dime

After 100 days, Medicare does not provide assistance for skilled nursing facility care. Other payment possibilities include personal funds, long-term care insurance, and Medicaid if these limited Medicare benefits are used up.

Does Medicare Pay For Home Health Care Coverage?

Medicare covers the expenses of having an agency give part-time or intermittent health care services in the patient’s home. Still, this coverage is limited, and the patient must need skilled assistance. The following conditions must be met to qualify for Medicare’s home health care benefit:

• It must be approved as medically necessary.
• A physician must authorize the treatment.
• The level of intermittent care required and supplied must be skilled care.
• A Medicare-certified home health agency must provide the care.
• Finally, the patient must be bedridden, which means that leaving the house takes a lot of effort and is rarely done.

Medicare will pay for medical social services, home health aide services, medical supplies, and durable medical equipment used in the home for qualifying patients. However, custodial home health care is not covered by Medicare.

Medigap Does Not Pay For Long-Term Care

Medigap plans, like Medicare, only cover a portion of long-term care services. Medigap policies are meant to fill in the gaps in Medicare caused by the numerous deductibles, co-payments, and other similar restrictions. These plans strive to fill in where Medicare leaves off. They are not intended to offer coverage or benefits for illnesses that Medicare does not cover.

As a result, since Medicare does not cover custodial care or extended stays in skilled nursing facilities, Medigap does not either. Other than post-hospital care in a skilled nursing facility, Medigap policies do not provide any benefits or payments for long-term care.

How To Pay For Long-Term Care At A Fraction Of The Cost

A long-term care annuity is a hybrid annuity set up to assist in paying for various long-term care services and facilities without causing retirement funds to be depleted. To create a tax-free Long-Term Care Insurance benefit, an LTC annuity doubles (200%) or triples (300%) the investment (based on medical records). If there is money in the annuity, it passes along a death benefit to beneficiaries.

If you don’t have a lump sum of money, another great option is a long-term care life insurance policy (LTCi). In simple terms, these policies are designed specifically for long-term care and allow the insured to access the life insurance’s death benefit while alive to pay for LTC costs. In addition, applicants can pay a fixed premium monthly or annually instead of a one-time deposit.

Next Steps

Planning for long-term care can be difficult, but it’s essential. Hopefully, this guide has given you a better understanding of Medicare and long-term care. If you have any questions or need help getting started, please don’t hesitate to contact us. We would be happy to assist you in any way we can. Thank you for reading!

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