As people age, the need for long-term care often arises. Whether it’s home health aides or nursing home care, the cost of long-term care can be quite high. Many people are wondering if Medicare will help cover the costs of these services. This article will explore in detail whether Medicare covers long-term care and what options are available for those who need assistance with these expenses.
Medicare is a national health insurance program administered by the United States government. It provides health care coverage for individuals who are aged 65 and over, as well as certain younger individuals with disabilities, and those with end-stage renal disease (ESRD). Medicare Part A covers hospitalization, skilled nursing facility care, home health services, and hospice care. Part A also covers long-term care services in certain circumstances.
Long-term care services are designed to assist individuals with activities of daily living (ADLs) such as bathing, dressing, eating, toileting, transferring from one place to another, and managing medications. Medicare Part A covers long-term care services that are medically necessary and provided in a skilled nursing facility or under the supervision of a doctor in the home or community setting. This includes physical therapy, occupational therapy, speech-language pathology services, medical social services and home health aide services. In order for Medicare Part A to cover these long-term care services they must be ordered by a doctor or other qualified healthcare professional and be provided on an intermittent basis or part-time basis (less than 8 hours per day).
Medicare does not cover custodial care which is non-medical assistance with ADLs such as help with bathing, dressing and meal preparation. Long term custodial care can be covered by Medicaid or private insurance policies that specialize in long term care insurance.
What is Medicare Part A?
Medicare Part A is a government health insurance program that helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home health care for people 65 and older or those who qualify due to disability or certain medical conditions. It is sometimes referred to as the “hospital insurance” part of Medicare.
Who is eligible?
Anyone age 65 or older who is a U.S. citizen or permanent resident, as well as certain people with disabilities and those with End-Stage Renal Disease (ESRD).
What does it cover?
Part A covers inpatient hospital stays, skilled nursing facility stays (up to 100 days), home health visits, hospice care, and certain lab tests and medical equipment. It also covers some preventive services such as flu shots and screenings for cancer and other diseases.
How does it differ from other parts of Medicare?
Part A differs from Parts B and D in that it only covers services related to hospitalization, while Parts B and D cover other types of medical services such as doctor visits, prescription drugs, durable medical equipment, and mental health services. Part A also has a deductible that must be paid before benefits begin.
Copayment & Cost of Coverage
Medicare copay requirements vary depending on the type of service or care being provided. For services that are covered by Medicare, such as doctor visits or hospital stays, there is usually a copayment required. This copayment is typically a percentage of the total cost of the service or care. For example, if a doctor visit costs $100, the patient may be responsible for 20% of the cost, or $20. In addition, some services may have additional fees associated with them such as deductibles and coinsurance. Deductibles are usually paid once per year and coinsurance is a percentage of the total cost that must be paid after the deductible has been met.
For services that are not covered by Medicare, such as most long-term care services, patients are typically responsible for 100% of the cost. This means that all costs associated with these services must be paid out-of-pocket by the patient or their family. It is important to note that some long-term care services may be partially covered by Medicare depending on certain criteria and eligibility requirements. Therefore, it is important to confirm coverage before receiving any care to ensure you understand what your financial responsibility will be.
Eligibility
To be eligible for Medicare, an individual must meet one of three criteria: they must be 65 years or older, have a disability, or have end stage renal disease.
For those who are 65 years or older, they can enroll in Medicare beginning 3 months before their 65th birthday. This allows them to receive coverage when they turn 65 and start to incur medical costs.
For those with a disability, they can enroll in Medicare beginning 3 months before they reach the 25th month of receiving disability benefits. This ensures that the individual has coverage for their medical needs as soon as possible after being diagnosed with a disability.
Finally, for those with end stage renal disease, enrollment times can depend on the individual’s situation. However, it is important that these individuals are able to access coverage as soon as possible so that their medical costs can be covered and they have access to necessary treatments.
Plan A Coverage
Services Covered by Part A
Medicare covers a variety of services related to part-time skilled nursing care or hands-on care, physical therapy, occupational therapy, speech-language therapy, and injectable osteoporosis drugs for women. Skilled nursing care is covered when the services are medically necessary and provided by a Medicare-certified home health agency. The services may include wound care, injections, and physical therapy. Medicare also covers physical therapy for treatment of injuries or illnesses that limit a person’s ability to move around or perform daily activities. This includes physical therapy to improve strength, coordination, balance, endurance and flexibility. Occupational therapy is also covered by Medicare for people with disabilities or chronic conditions that limit their ability to perform everyday tasks. This type of therapy helps people learn how to do everyday activities such as dressing and bathing independently. Speech-language therapy is also covered by Medicare when it is medically necessary to treat a speech or language disorder caused by an illness or injury. Finally, Medicare covers certain injectable osteoporosis drugs for women who have been diagnosed with osteoporosis. These drugs can help reduce the risk of fractures in women who are at high risk for them due to low bone density.
Services Not Covered by Part A
Medicare does not cover a variety of services such as long-term care, vision, hearing and dental services. Medicare Advantage plans are offered by private companies and provide additional coverage beyond what Original Medicare offers. These plans may include coverage for vision, hearing, dental and other health care services not covered by Original Medicare. Medigap is an additional insurance policy that helps cover some of the gaps in Original Medicare coverage. It does not cover long-term care or vision, hearing or dental services. Medicaid is a government program that provides health care coverage for people with low incomes or disabilities who meet certain eligibility criteria. It covers some health care services that are not covered by Medicare, such as long-term care, vision and hearing services. Long-term care insurance helps pay for long-term medical and non-medical care for people who need assistance with activities of daily living due to a disability or chronic illness. Program of All-inclusive Care for the Elderly (PACE) is a program offered by some states that provides comprehensive medical and social services to elderly individuals who meet certain eligibility requirements. The Department of Veterans Affairs (VA) provides health benefits to veterans who meet certain eligibility requirements, including some services that are not covered by Medicare such as long-term care and vision and hearing services. Out-of-pocket expenses are those costs that must be paid directly by the patient rather than through insurance or another payment source; these can include co-pays, deductibles and other expenses related to medical treatment that are not covered by insurance or other programs such as Medicare.
Conclusion
In conclusion, Medicare Part A provides coverage for long term care services. This coverage can help those who need assistance with activities of daily living and skilled nursing care. It is important to understand the details of your coverage and to make sure that you are taking advantage of all the benefits available to you. Taking the time to research your options can help ensure that you have access to the best care possible.
