Broker Check

Long-Term Care and Medicare Myths

April 29, 2023

Planning is critical regarding long-term needs, but many people are unsure what insurance covers, and others are often misinformed about Medicare coverage. Additionally, there are differences between Medicare and Medicaid regarding coverage to be aware of. Let's explore:

Medicare. There are many common misconceptions about what Medicare covers and doesn't cover. Medicare only pays for long-term care if you require skilled services or rehabilitative care. But there are limits.

  • Medicare will cover a nursing home for a maximum of 100 days. The average Medicare-covered stay is a much shorter 22 days.
  • It will also pay if you are at home and are receiving skilled home health or other skilled in-home services. Generally, long-term care services are provided only for a short period.

Medicare does not pay for non-skilled assistance with activities of Daily Living, which comprise most of the long-term care services. These would include bathing, eating, getting dressed, getting in and out of bed, walking, and assistance using the bathroom. You will have to pay for long-term care services that are not covered through a public or private insurance program.

Medicaid. Medicaid pays for the largest share of long-term care services for those that qualify. To qualify, your income must be below a certain level and meet minimum state eligibility requirements. The income limit for Medicaid varies by state, so it's necessary to know where you'll be living in retirement to know specific limits.

Regarding qualification, Medicaid will count things such as Social Security and disability benefits, pensions, salaries, wages, and interest and dividends. Medicaid will also review your assets, including those counted for eligibility. These include checking and savings accounts, stocks and bonds, CDs, and property outside your primary residence.

However, equity in your home may affect whether Medicaid will pay for long-term care services, including nursing home care and home and community-based waiver services.

That said, if there is just one takeaway, realize that Medicare coverage for long-term care is limited, and there are hurdles that may prevent you from obtaining Medicaid. Now is the time to explore and understand your health coverage and long-term needs. If you have questions, we'd be happy to assist you.


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