By Gregory F. Quinn
Clients sometimes ask, “Will Medicare cover nursing home expenses?” Here are three surprising facts you can’t ignore.
On its website, the Medicare program talks about the number of people who will eventually need nursing home care. They provide the following information.
Are you sitting down?
1) By 2020, 12 million older Americans will need long term care.
2) People who reach the age of 65 will likely have a 40 percent chance of entering a nursing home.
3) About 10 percent of the people who enter a nursing home will stay there five years or more.
It is not unusual for nursing home care to cost $6,500.00 a month or more. Privately paying for a nursing home can often cost seniors in excess of $75,000.00 per year. Given this cost, long term care can quickly take a devastating toll on a family’s budget. These costs can completely drain someone’s life savings. Most people are generally familiar with the Medicare program and that it pays for certain health care costs for people 65 years old or older. But will Medicare pay for long term care?
Medicare’s coverage for nursing home care is very limited and often doesn’t pay for long term care. Even if it does pay, it only covers up to 100 days of skilled nursing care per illness. Frequently, if certain requirements are not met, Medicare’s coverage of skilled nursing care will cease prior to the 100-day maximum.
The coverage Medicare provides is for acute, short-term medical care and rehabilitative services. These services are typically referred to as “skilled nursing care.” When most people think of nursing home care, they are thinking of “custodial care.” Some examples of custodial care include assistance with bathing, dressing, transferring from the bed to a chair and toileting.
The Medicare program on its website, Medicare.gov, explains the limitations of its coverage for custodial long term care:
“Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing and using the bathroom. Medicare doesn’t pay for this type of care called “custodial care.” Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring. Some Medicare Advantage Plans (formerly Medicare + Choice) may offer limited skilled nursing facility and home care (skilled care) coverage if the care is medically necessary. You may have to pay some of the costs.”
It’s clear that people must look to a source other than Medicare to pay the substantial cost of custodial care in a nursing home. The good news is that there are solutions that can preserve and protect your assets from the potentially devastating costs of long term care.
A knowledgeable elder law attorney can recommend legal and financial strategies to keep you from losing your life savings in a nursing home. Since each person’s situation and goals are different, each person’s solution must be customized to meet their own individual needs. Generally, the earlier you start, the more options you will have available to you.
Contact us today and we will be happy to assist you in achieving your goals with the best plan for your circumstances.
Written by Gregory F. Quinn, Esq.