Medicare generally will not pay for the cost of long term care (LTC) because Medicare pays for only medical help - not nonskilled living assistance care which is what LTC refers to. But often a situation of LTC occurs in conjunction with a medical problem. Then Medicare will pay - but only for a short term. Here's the scoop...
The Medicare program that Americans rely on after they turn 65 provides for a variety of medical treatments. These include hospital, physician, skilled nursing costs and some drug prescription costs. It's a complicated program.
Long term care (LTC) generally refers to the nonmedical skilled (called unskilled or custodial) care that older people need when they can't perform - or need help with - some of their activities of daily living (ADLs). This help is not considered medical help - and that's why Medicare doesn't cover it when there's no overriding medical issue. So Medicare doesn't cover typical LTC costs.
*When Medicare covers short term LTC:
Often, a person may suffer a medical problem that then leads him into a circumstance where typical LTC is required - perhaps in a nursing home. In this 'medical care to LTC transition' some Medicare assistance is available. Here's the circumstance.
For Medicare to help you with LTC costs, three criteria must be met:
1. You have a medical necessity,
2. The 72 hour rule, and
3. A Place where care can be given The medical necessity means that your care must result from a condition for which you were hospitalized. It must be medically necessary and given by skilled personnel in a place such as a nursing home.
Your hospitalization must have lasted for a full 72 hours. That means 3 days and 3 nights.
A place where care can be given means that you were taken from your hospitalization directly to a nursing home where you can receive skilled care related to your hospitalization. That's because Medicare pays for medically necessary skilled care in a nursing home setting.
*How long will Medicare Pay for you in a nursing home
If you meet the above criteria, Medicare may perhaps pay up to 100% of your costs in a nursing home for the first 20 days in a benefit period. To go beyond that 20 days, you'll be required to pay a co-insurance amount from day 21 through 100.
Two further exceptions to the Medicare's limited nursing home care exist. Medicare can pay a skilled caregiver to come to your home if it's a medical necessity and you're homebound. Also end-of-life or hospice care can be covered. You'll have to check what your state specifically allows for costs, though.
The Medicare program that Americans rely on after they turn 65 provides for a variety of medical treatments. These include hospital, physician, skilled nursing costs and some drug prescription costs. It's a complicated program.
Long term care (LTC) generally refers to the nonmedical skilled (called unskilled or custodial) care that older people need when they can't perform - or need help with - some of their activities of daily living (ADLs). This help is not considered medical help - and that's why Medicare doesn't cover it when there's no overriding medical issue. So Medicare doesn't cover typical LTC costs.
*When Medicare covers short term LTC:
Often, a person may suffer a medical problem that then leads him into a circumstance where typical LTC is required - perhaps in a nursing home. In this 'medical care to LTC transition' some Medicare assistance is available. Here's the circumstance.
For Medicare to help you with LTC costs, three criteria must be met:
1. You have a medical necessity,
2. The 72 hour rule, and
3. A Place where care can be given The medical necessity means that your care must result from a condition for which you were hospitalized. It must be medically necessary and given by skilled personnel in a place such as a nursing home.
Your hospitalization must have lasted for a full 72 hours. That means 3 days and 3 nights.
A place where care can be given means that you were taken from your hospitalization directly to a nursing home where you can receive skilled care related to your hospitalization. That's because Medicare pays for medically necessary skilled care in a nursing home setting.
*How long will Medicare Pay for you in a nursing home
If you meet the above criteria, Medicare may perhaps pay up to 100% of your costs in a nursing home for the first 20 days in a benefit period. To go beyond that 20 days, you'll be required to pay a co-insurance amount from day 21 through 100.
Two further exceptions to the Medicare's limited nursing home care exist. Medicare can pay a skilled caregiver to come to your home if it's a medical necessity and you're homebound. Also end-of-life or hospice care can be covered. You'll have to check what your state specifically allows for costs, though.
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