Medicare serves as the primary source of insurance coverage for more than 50 million Americans, most of whom are seniors. But when there is a need for long-term care, there's not as much of a safety net available as recipients may think. Medicare tends to provide better coverage for short-term care needs and medical-related expenses. While there are some limitations with what Medicare covers, some benefits can help recipients pay for care. Here's a closer look at what type of coverage is available in various situations.
If in-home skilled nursing care is needed, Medicare will provide coverage for a certain period of time. However, non-medical care service, like providing assistance with daily routines, is not covered. In order to qualify for coverage, home-bound seniors must have this type of care prescribed by a doctor. Only part-time care is covered.
Assisted Living and Skilled Nursing Facilities
In assisted living situations, Medicare will only pay for medical costs incurred while residing at such a facility. Adult day care services are not covered by Medicare. However, full coverage is provided if a senior needs to temporarily stay at a skilled nursing facility following inpatient hospitalization. All costs are covered up to 20 days. Eighty percent of costs are covered for 80 additional days after the initial period.
Alzheimer's and Dementia Care
Medicare will only cover medical care related to Alzheimer's disease. Medicare recipients in the end-stage of Alzheimer's do have an available hospice benefit. Personal care costs for Medicare recipients with Alzheimer's and other forms of dementia are not covered.
If a doctor determines that a terminally ill Medicare recipient has six months or less to live, hospice care is covered. Room and board are not covered if a senior needs to stay at a hospice facility, although medical costs are covered. Coverage is provided for homemaker services related to hospice care and prescription drugs. This type of care can also be provided at home.
Because of the shortcomings of certain types of original Medicare coverage, some seniors with care needs that aren't short-term opt to expand their coverage with other forms of medical insurance. One option is Medicare supplement insurance, also referred to as Medigap. Another possibility is to separately purchase long-term care (LTC) insurance, something only just over 7 million Americans have. In order to qualify for Medicare, seniors must be 65 or older or entitled to disability benefits from Social Security.
To learn more about Medicare benefits, contact an agent at the Della Porta Agency today.