If you’re approaching retirement, you’re probably considering your health care coverage options. Medicare will almost certainly play a role in your strategy. Medicare is a valuable retirement resource that provides health care protection for 44 million Americans, or 15 percent of the population.1

Medicare doesn’t cover every health care expense for retirees, though. A number of treatments are only partially covered by Medicare or aren’t covered at all. For example, traditional Medicare often doesn’t cover dental care, rehabilitation or a wide range of prescription drugs.

Long-term care is another common form of treatment that may not be covered by Medicare. That can be a problem because long-term care is also widely needed by retirees. The U.S. Department of Health and Human Services estimates that today’s 65-year-olds have a 70 percent chance of needing long-term care in the future.2

Unfortunately, the rules about what care is and is not covered by Medicare can be murky. Below are a couple of questions to ask to help you better understand whether your long-term care would fall under Medicare coverage:

 

Are you receiving skilled nursing or custodial care?

 

One of the biggest factors in determining whether long-term care is covered by Medicare is the nature of the care itself. Medicare does partially and temporarily cover skilled nursing care. However, it doesn’t cover an alternate type of care known as custodial care.

Skilled nursing care includes a medical component. It may consist of help with basic daily activities such as eating, bathing and mobility. It also includes treatment, however, with the objective of recovery. Skilled nursing care is usually prescribed by a doctor and is administered by a skilled professional like a nurse.

Custodial care doesn’t involve medical treatment. Rather, it simply involves extended assistance with basic daily living activities. It could be an in-home aide who helps with meals and basic tasks. Or it could be provided in an assisted living facility where aides can help with a wide range of activities and challenges.

The key distinction is the objective of the care. Skilled nursing care is usually needed as a result of a specific medical issue, and recovery is often the primary objective. That means skilled nursing care is meant to be a temporary need.

On the other hand, custodial care is often the result of a gradual decline in health and cognitive ability. Recovery isn’t likely, so the goal is to maintain a comfortable standard of living. This kind of care is often associated with cognitive disorders such as Alzheimer’s or Parkinson’s.

 

Where is the care provided?

 

Another important factor is where the care is provided. If the care is provided in the home, it’s very difficult to qualify for Medicare coverage. The care must be mostly medical in nature, prescribed by a doctor, and the individual must be confined to the home.

It’s also possible that care could be provided in an assisted living or adult day care facility. Some of these facilities provide medical services, but they largely provide custodial care. Medicare may pay for some of the medical treatment but usually won’t pay for room and board or custodial assistance.

It’s also possible that you could be admitted to a long-term hospital for skilled nursing care and treatment. Medicare will temporarily cover this type of care, assuming it’s preceded by a three-day stay in a hospital and is a result of a specific medical condition.3 Depending on the length of the hospitalization, you’ll likely share the cost with Medicare. The coverage schedule breaks down as follows:

  • Days 1-20: Full Medicare coverage
  • Days 21-100: Partial coverage depending on deductibles and copays
  • Days 100+: No Medicare coverage3

 

As you can see, Medicare is unlikely to meet all of your long-term care needs. It may be wise to develop an alternate funding strategy, perhaps including a long-term care insurance policy. Contact us today at Crescent City Retirement for more information. We can help you analyze your needs and budget and implement a plan.

 

1https://assets.aarp.org/rgcenter/health/fs149_medicare.pdf

2https://longtermcare.acl.gov/the-basics/how-much-care-will-you-need.html

3https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care

 

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18154 – 2018/10/17