The population of the United States is aging and becoming increasingly long-lived, and with it, the demand for long-term medical services and costs: the needs of these medical benefits and their prices are skyrocketing, in the midst of complicated inflation for our country.
According to the portal LongTermCare.gov a person who is 65 years old today has almost a 70% chance of needing some long-term medical service in the years he has left to live, and that care represents a significant cost.
The costs of housing for retirees are also one of the reasons why many look at their future with concern: for example, a semi-private room in a nursing home costs an average of about $104,000 a year, while a totally private room costs much more, about $117,000.
Knowing all this, families with dependent retirees count on Medicare’s help to round up their budgets and cover the cost of long-term care, when the need arises. Now we ask ourselves: how much does Medicare cover in this type of services for the elderly?
Does Medicare Cover Long-Term Care Costs? What You Need to Know
Broadly speaking, Medicare does not cover the costs of long-term care services that help with activities of daily living for an extended period. Among the services that are not included in Medicare are those non-medical services, such as hiring staff to help an elderly person bathe, get dressed, eat, go to bed and get out of bed and use the bathroom.
As stipulated in the general provisions of Medicare Part A (hospital insurance) and Part B (medical insurance), the user must assume 100% of the costs of most long-term care that is considered custodial and not related to specialized medical care. On the other hand, Medicare supplement plans, popularly known as Medigap, also do not offer coverage for this type of non-medical care.
Despite all of the above, according to the website medicare.gov , there are some exceptions in which Medicare temporarily covers some types of non-medical long-term care, which are as follows:
Despite all of the above, according to the website medicare.gov , there are some exceptions in which Medicare temporarily covers some types of non-medical long-term care, which are as follows:
- Up to 100 days of specialized care in a nursing home are covered as long as it is due to illness, through Medicare Part A.
- Limited palliative care coverage for terminally ill patients through Medicare Part A.
- Some additional coverage, through Medicare Part B, for specific home health care services, such as intermittent skilled nursing physical therapy and occupational therapy, as long as it is considered medically indispensable.
This is why many seniors and their families exhaust their savings and personal assets by paying for non-medical long-term care costs, before they are even eligible to qualify for Medicaid.
Everything’s Not Lost: Medicaid May Be the Answer
Medicaid does cover non-medical long-term care for those who qualify based on income requirements and other criteria set by each state. This may include services such as personal assistance at home, care in a nursing home, or in a long-term care facility.
To qualify for Medicaid, certain income-related requirements and other criteria set by each particular state must generally be met. Some of the groups of people who typically qualify for Medicaid include:
- Low-income people: Those whose income is below a certain level determined by the state may qualify for Medicaid. This level varies depending on the size of the household and other factors.
- Families with Children: Parents and caregivers of children under a certain age may qualify for Medicaid if they meet the state’s income requirements.
- Elderly and disabled people: People over the age of 65, as well as those with disabilities, may be eligible for Medicaid if they meet the income requirements and other eligibility criteria established by the state.
- Pregnant Women: Pregnant women may qualify for Medicaid during pregnancy and after childbirth, as long as they meet the state’s income requirements.
- Adults without dependent children: Some states expanded Medicaid eligibility to include adults without dependent children, as long as they meet the state’s income requirements and other criteria.