Medicare: What It Can and Can't Provide

Medicare is the federal government's health insurance program for the disabled and for people over sixty-five. Many Americans believe Medicare will pay their long-term care bills. In fact, Medicare pays only under certain conditions and only for a limited number of days. Currently, Medicare may cover skilled care in a nursing home for (up to) the first 20 days, and a portion of the cost for (up to) the next 80 days if admission follows (at least) a three-day hospital stay and the individual needs skilled care. The "need" for skilled care is determined according to specific Medicare criteria. To receive home care benefits from Medicare an individual must also meet specific Medicare guidelines.

The biggest gaps in Medicare coverage are:

• No coverage for "custodial" care, either at home or in a nursing home. (Care is considered custodial when an individual's condition is stable, care needs have not changed over a period, and care needs are not expected to change. Custodial care is care considered routine enough that any competent adult might be taught to perform it.)
  
• No coverage in a nursing home unless it immediately follows hospitalization of at least three days.
  
• No coverage for nursing home care after 100 days.
  
• Coverage only through a facility or home health care agency approved by Medicare.

Medigap Plans and Medicare Advantage Plans are supplements to Medicare sold by insurance companies. They pay for some of the costs not covered by Medicare. They do not, however, provide coverage for long-term care, although they may provide some coverage for short-term nursing home care at Medicare-participating facilities.

Medicaid

Medicaid is a joint federal/state program that pays for health care for people with limited income and assets. To receive Medicaid benefits, the recipient must meet federal poverty guidelines for income and assets. This means, for example, that most of your loved one's assets will need to be "spent down" or used up before he or she becomes eligible. To obtain information about the Medicaid program, contact your local Medicaid office or Department of Social Services.

Check out more about elder care.