What long-term care costs does Medicare cover?
Over the past few decades, the expenses associated with extended medical care, assisted living and nursing home facilities have surged. According to data from Genworth, the average cost of a private room in a nursing home now exceeds $100,000 per year. And, assisted living facilities, while somewhat less expensive, still command an average yearly fee of over $50,000. Even in-home care services, often seen as a more affordable option, can quickly drain savings.
Given the magnitude of these potential expenses, it's important to plan for long-term care well before retirement. But many people expect their Medicare coverage, which they rely on to manage their healthcare costs after they stop working, to cover them. After all, these programs provide essential coverage for a wide range of medical needs, from routine check-ups to hospital stays and prescription drugs, significantly reducing the out-of-pocket expenses for many medical services.
While Medicare can be an invaluable resource for retirees, however, the program was designed to cover acute medical needs and short-term care, not the kind of extended support often required in long-term care situations. This raises an important question: What long-term care costs does Medicare actually cover?
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What long-term care costs does Medicare cover?
Medicare's coverage of long-term care costs is quite limited. Here's what Medicare does and doesn't cover in terms of long-term care:
Skilled nursing facility care
Medicare Part A will cover skilled nursing facility care, but only under specific conditions and for a limited time. To qualify, you must have had a qualifying hospital stay of at least three days and require skilled care related to that hospitalization. Coverage is limited to 100 days per benefit period, with full coverage for the first 20 days and partial coverage for days 21-100.
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Home health care
Medicare will cover part-time skilled nursing care, physical therapy, occupational therapy and other skilled care services provided in your home if you meet certain conditions. However, this coverage is typically short-term and does not include 24-hour care, meal delivery, or help with activities of daily living like bathing and dressing.
Hospice care
For those with terminal illnesses, Medicare provides comprehensive hospice coverage, including medical care, prescription drugs for symptom control and support services for patients and their families.
Hospital stays
While not typically considered long-term care, Medicare does cover inpatient hospital stays, which can sometimes be extended in cases of severe illness or injury.
It's important to note that Medicare does not cover:
- Custodial care (help with activities of daily living) when that's the only care needed
- Long-term care in assisted living facilities or nursing homes beyond the limited skilled nursing facility coverage mentioned above
- Non-medical home care services
How to cover the costs of long-term care
Given these limitations, relying solely on Medicare for long-term care needs is not a viable strategy for most retirees. Here are other strategies you may want to consider instead:
Long-term care insurance
The right long-term care insurance policy is often the most comprehensive solution for addressing long-term care costs. That's because long-term care insurance is specifically designed to cover the expenses for extended care needs, including assisted living, nursing home care and in-home care services.
These policies will typically offer:
- Comprehensive coverage: Policies can be tailored to cover a wide range of care options, giving you flexibility in choosing the type of care you receive.
- Asset protection: By covering care costs, long-term care insurance helps preserve your savings and assets for other purposes or for inheritance.
- Customization options: You can choose the level of coverage, benefit period and other features to suit your needs and budget.
- Tax advantages: Premiums may be tax-deductible, and benefits are generally received tax-free.
Medicare supplemental coverage
Medicare supplemental coverage is another option you have to help cover certain long-term care costs. For example, if you have this type of coverage, it may cover the daily coinsurance for stays in a skilled nursing facility for up to 100 days, reducing out-of-pocket costs for short-term rehabilitation or skilled nursing care.
However, it's important to understand the limitations. When it comes to extended stays in nursing homes, assisted living facilities or ongoing home health care, Medicare supplemental policies fall short. That's because these policies are designed to fill gaps in original Medicare coverage rather than provide extensive long-term care support.
For comprehensive long-term care protection, a dedicated long-term care insurance policy would be more appropriate. But in some cases, you may be able to use your Medicare supplemental policy to cover at least some of the costs associated with this type of care. Find out what your best Medicare supplemental coverage options are here.
Savings and investments
Building a dedicated fund for long-term care expenses through consistent saving and strategic investing can help offset future costs. This approach requires discipline and early planning but offers flexibility in how funds are used.
Health savings accounts
If you're eligible, contributing to a health savings account (HSA) while you're still working can provide a tax-advantaged way to save for future healthcare expenses, including some long-term care costs.
Medicaid
Medicaid can provide more extensive long-term care coverage for those who meet income and asset requirements. However, this option typically is geared toward low-income seniors and requires that you spend down assets to qualify — so it generally won't be an option for those with substantial retirement savings or assets.
The bottom line
As the cost of long-term care continues to rise and life expectancies continue to increase, taking proactive steps to address long-term care needs is an essential part of comprehensive retirement planning. And, while Medicare plays a crucial role in providing healthcare coverage for seniors, its limited long-term care benefits highlight the need for additional planning. Luckily, by understanding these limitations and exploring alternative options like long-term care insurance, you can be better prepared for the potential costs associated with aging.
