Is Medicare an option for Long Term Care Services?


Qualifying for Medicare

Medicare is a national health insurance program for people 65 years of age and older, certain younger disabled people and people with permanent kidney failure. Like your regular health insurance, it is not intended to provide long term custodial care!

The following criteria must be met in order to qualify for Medicare to pay for any of your long-term care bills:

Must have a hospital stay of three consecutive days (not counting the day of discharge)
Be admitted to a nursing facility for the same illness you were hospitalized for within 30 days of discharge
Be receiving skilled care only
Be certified by a medical professional that you need skilled nursing or rehabilitative services daily

How Much Will Medicare Pay For a Nursing Home?

100% of the first 20 days (providing you are receiving daily skilled care)
Days 21-100, you pay the first $101.50 per day and Medicare will pay the balance
After day 100, Medicare pays nothing

How Much Will Medicare Pay For Home Health?

Home Care Visit must require skilled care or rehabilitative care only (i.e. patient must get better.)
Will pay for Visits Only (Average visit is 1-2 hours)

Types of Care Received

The reason it is so difficult to get Medicare to cover any of your LTC stay is that most people do not receive skilled care on a prolonged basis. The majority of people are receiving custodial care, which is assistance with their activities of daily living.  

Care Percentage Breakdown







The Percentage breakdown above shows that most care provided is custodial and not covered by Medicare.

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