Medicare and Long-Term Care: Understanding Your Options

It’s one of the things no one wants to think about, but eventually most people will need some form of long-term care. And while that might seem daunting, it is important to understand long-term care options and what you can do to prepare for long-term care.

Does Medicare Cover Long-term Care?

Medicare does not cover long-term care. This includes nursing homes and community assistance programs. It will only cover short-term skilled nursing care. Medicare covers skilled, short-term care through your Part A benefits.

Those seeking long-term housing will need to fund it through non-Medicare services. Some seniors may be eligible for Medicaid assistance if they have low incomes and no assets to assist in payment for long-term care, but this is not something seniors should count on having because the criterion for receiving the assistance is very strict.

What are long-term care options?

For most people, long-term care means finding a custodial care option. Custodial care is any care that is nonmedical and is not covered by Medicare. Here are a few examples of custodial care:

Home and community services

Home and community services can vary a lot. Often, this type of care is living with a family member who provides for your basic care. Community care options might be local programs that can help during the daytime at a community senior center. Some of these services can also be covered by Medicaid.

Accessory dwelling unit (ADU)

An ADU may also be called an “in-law apartment,” “accessory apartment” or a “second unit.” Regardless of which term you use, it must consist of a separate living and sleeping area, a place to cook and a bathroom on the same lot as a traditional single-family home. This is a popular choice for those with mobility who want to be near family and still have their freedom.

Subsidized senior housing

There are state and federal programs that help pay for housing for some seniors with low to moderate incomes. This housing option is not a Medicare program and is not covered by Medicare. Check your state’s regulation or talk with a Social Security agent for more on this program in your area.

Group living arrangements

There are two main types of group living arrangements: residential care communities and assisted living communities. Residential care communities — which are typically for those who require less assistance — and assisted living communities are surprisingly similar. In fact, some states view both as the same thing.

Both can help with some of the activities of daily living, like bathing, dressing, using the bathroom and meals. The main difference comes with medical assistance. Whether they offer nursing services or help with medications varies by state. To make sure you are choosing the correct option for you needs, we suggest talking with potential living centers to find out what services they offer.

It is also important to remember that neither residential care nor assisted living are covered by Medicare. Financial planning for long-term care is just one of the ways you can help your future self. Planning now will save a lot of frustration for you and your loved ones in the future.

Continuing care retirement communities (CCRCs)

Some retirement communities offer different kinds of housing and levels of care. These are often what we think of when we think about nursing homes. Residents can move from one level to another based on their needs, but usually stay within the CCRC. In the same community, there may be:

• Individual homes or apartments (for residents who still live on their own)
• An assisted living facility (for people who need some help with daily care)
• A nursing home (for people who require higher levels of care)

What is skilled care and why would I need it?

Skilled care is care administered by medical professionals. Skilled care options are usually explored when someone needs significant medical assistance. This is often due to illness, like cancer, or after surgery or other major medical treatments. Many skilled care options are only used when someone is terminally ill, such as hospice.

What are my skilled care options?

Hospice

Hospice is a program of care and support for people who are terminally ill. Hospice helps people who are near death have as much comfort as possible in their final days. The focus is on comfort, not on curing an illness. Hospice is only used during the final period of one’s life and is, by the nature of its purpose, not meant to last longer than six months.

Respite care

This is a very short inpatient stay at a medical facility given to a hospice patient so that their usual caregiver can rest. If you have one family member providing all of your care, this type of service can give them peace of mind knowing you are safe if they need a night off or are too sick to care for you themselves.

PACE (Program of All-inclusive Care for the Elderly)

PACE is a Medicare/Medicaid program that helps people meet health care needs in community. For more information, see Medicare’s page on PACE.

Do Medicare Supplement plans cover long-term care?

No. Even the most inclusive supplement plans do not cover long-term care. However, that does not mean that you are without hope. Many insurance providers offer long-term care insurance options that can help you prepare for the future while giving you peace of mind today. If you are interested in reviewing your long-term care options, please contact one of our licensed insurance agents.

Conclusion

Long-term care may not be something we want to plan for, but it is something many of us will need. Understanding your options, including payment possibilities, can help you make informed decisions and prepare for the future.

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