UNIT 21 Flashcards
MEDICARE’S LONG TERM CARE COVERAGE
Medicare assistance is available for short-term stays in a skilled nursing facility, for hospice care, and home health care as long as the insured has recently been in the hospital for at least 3 days and has been admitted to a Medicare-certified nursing facility within 30 days after the hospital and skilled nursing, physical therapy, or other skilled care is needed.
Costs for skilled care in a nursing home are covered for up to 100 days. The first 20 days are covered up to 100% by Medicare. However, the insured is responsible for a daily co-payment for days 21-100, and there is no Medicare coverage after day 100. Hospice care, other than grief counseling, is covered if the insured has a terminal illness and is not expected to live more than 6 months.
Medicare also provides some home and other care services as long as they are medically necessary to treat an injury or illness. As long as a doctor, every 60 days, determines this care is medically necessary, there is no limit on how long the care may be received.
Medicare Supplement insurance plans also do not cover long-term care needs such as custodial care, adult day care, care for those with Alzheimer’s disease, or assisted living.
MEDICAID’S LONG TERM CARE COVERAGE
Medicaid covers the type of Long-term care most people need, but only if they are impoverished. This is in keeping with Medicaid’s Purpose of providing a safety net for the poor. Many of the elderly Americans whose long term care costs are paid by Medicaid did not start out poor. They spent themselves into poverty paying for their own long-term care. Once they are on Medicaid, all of their income except for a small monthly allowance must go to help pay for their care. After a Medicaid beneficiary dies, Medicaid has the right to recover the amount of benefits paid on that person’s behalf from assets in the deceased beneficiaries estate.
