Long Term Care: What Medicare Covers - YouTube

Today's lesson is, we're going to talk  about what Medicare actually does pay  

for and toward long-term care. A lot of folks that  come to us, and they're talking about long-term  

care insurance, they're talking about Medicare  insurance, they're talking about financial  

planning for retirement, are under the mistaken  assumption that Medicare is going to pay all  

their long-term care, and the fact is it doesn't.  We're going to show you today exactly what it does  

pay for. The first thing that it's going to pay  for a skilled nursing facility, or some folks  

times folks are going to call this rehab, and  either you have or you know somebody that has,  

where you go to the hospital typically this is  for older folks, you're in the hospital, and  

the way they push you out of the hospital is they  push you across the street to the rehab facility,  

and you're there a couple three weeks, now some  folks are there much longer, some people folks  

are just there a few days. Medicare is going to  cover this under some rules and then of course  

your Medicare Supplement insurance coverage is  going to pay as long as Medicare approves it, it's  

going to pay as well, and so once you've met all  the rules, you're going to get the first 20 days  

in a skilled nursing facility covered. Now  they're going to review you every week,  

maybe every day, Medicare is and the staff there,  to make sure you're still Medicare certified and  

Medicare is going to pay up to 100 days and  they're going to do those next 80 days where  

if you've got some co-insurance and that  kind of stuff, but the real issue is is  

whether they approve it or not. When you look  at the average of payment toward nursing homes,  

it's about two percent that Medicare covers,  so that leaves 98 of the nursing home expenses  

uncovered by Medicare. For assisted living,  which a lot of times folks they'll use nursing  

facility or nursing home and assisted living  interchangeably, and there's a lot of things  

about them that are similar, there's no coverage  from Medicare for assisted living facilities.  

Adult day care, same thing, there's no Medicare  coverage for adult day care. Now for home health  

care it gets a little bit tricky because if  they're doing skilled care or they're performing  

what is skilled nursing care for you, and  you meet all the other criteria for Medicare  

payment that you would have if you were in a  nursing home or a nurse skill nursing facility,  

a bunch of rules bunch of regulations, but once  you qualify, then it's fairly limited what they're  

going to pay for. It's this part-time care, or  a thing called intermittent care, where they're  

coming in and doing something for you  and with you, like physical therapy,  

that sort of thing, and you need to be home  bound to get Medicare to pay for it, you can't be  

able to leave your house. It needs to be ordered  by a doctor. If you need more coverage than  

part-time intermittent care, then you don't even  get the skilled portion of this paid for, so in  

other words if you need a whole bunch of care or  several hours of care and you need it every day,  

they're not even going to cover the skilled  portion of that. There's no coverage for  

custodial care, which is the activities of  daily living, like bathing, dressing, and so on,  

which is really where most of the long-term care  is incurred in the expense for it. Now hospice.  

Medicare will cover hospice care, but in order to  get on Medicare hospice or to get into hospice,  

a doctor needs to certify that you have  six months or less to live and then  

Medicare is then going to get out of paying for  all the life prolonging care, which is what most  

of medicine is, and they're simply going to  pay for care to make you more comfortable. So  

really you're only going to get coverage in  three of these places, skilled, home health care,  

and hospice, and then it's fairly limited  coverage with a bunch of rules. I'm Hans Scheil,  

I've written a couple of books on these subjects  within retirement, and I thank you for listening.