Medicare and Long Term Care

Quick…how will you pay the costs of the nursing home, assisted living, or home care costs should you or a family member ever need one of them?


Medicare, right? That answer is almost always wrong. And, even if Medicare pays, it only pays part of the cost and only for a short while. Worst, it only pays for skilled nursing care following a three-day/three-night hospital stay. Think about how few people spend three full days in the hospital anymore. It’s more likely to be three days and two nights, and then Medicare does not pay for follow-on nursing home (or similar) care, regardless of the illness or injury.

Very few people who need long-term or follow-on care need skilled nursing care- they need custodial care. If professional care is required, it is not usually required for very long, and not many people meet the 72-hour hospital stay requirement anyway. You may be in the hospital for several days or weeks if you have a severe illness or injury (for example, a hip fracture or bypass operation). Still, when you are released, you rarely need skilled nursing care. You are far more likely to need help dressing, getting to appointments, or cooking your meals, and you may not be able to care for yourself and end up in a long-term care facility. But, the care you need is easily given by semi-skilled or unskilled workers- not RNs or other medical staff.

Assuming you need skilled nursing care, Medicare pays for 20 days at 100% and 21-100 at $128.00/day (more or less, depending on your state). That is nowhere near the average day cost in a nursing home or similar facility. Depending on whose statistics you use, a day in a long-term care facility costs $110-$300 or more.

Of course, you could buy a Medicare supplement plan, but that plan only supplements the benefits provided under Medicare. Since Medicare does not cover custodial or unskilled care, a Medicare supplement policy will not likely help.

So, what can you do? There are a few options.

First, many people will need long-term care, but many won’t. You may not need to do anything if your family history doesn’t include stays in long-term care facilities. But, if your medical condition is not as good as other family members, you might be the exception. So, gambling isn’t always a good idea.

Medicaid may cover your expenses if you have a pension, a house, and other assets. It is a good idea to find out before the need arises. Not all care facilities accept Medicaid, and those that do may put you in a separate area. And, you are likely to have a roommate (and it is not expected to be your spouse!).

If you have substantial assets and are prepared to spend them, ensure you have checked out the various care facilities so your family knows where you want to go.

Finally, consider purchasing a long-term care insurance policy if you have significant assets above pension payments. It could be the best investment you ever make. And, in some states, the premium may even be tax-deductible.

Each state has somewhat different coverage. It is helpful to visit our Medicare site for complete, state-specific information.

Contact Brian Gruss (352) 508-4221 about your Medicare and Long Term Care Insurance options.