Why You Can’t Rely on Medicare for Long Term Care

The Chamberlain Law Firm

Like many of today’s aging adults, you may be starting to look at long term care options for yourself or a loved one. This is especially true if you are considering the possibility of care in your home, an assisted living facility, or at a nursing home care. Unfortunately, relying on Medicare is not an option.

This may be a surprise to some who have been counting on Medicare for future living options. Medicare is undoubtedly an excellent program for aging and disabled adults; it provides recovery services in a skilled nursing facility in the event that a patient needs additional care coming out of a hospital stay, pays for home health care when a patient is homebound following an injury or illness, and pays for hospice services in the event of terminal illness

However, Medicare is limited in its scope. Although it is true that Medicare will pay for a few types of elder care, you cannot rely on it for long term care.

Long Term Care’s High Cost

Put bluntly, long term care in New Jersey is expensive. According to the state of New Jersey, the cost of long term care in the Garden State can exceed $65,000 per year. Coupled with the fact that the state estimates the average stay in a long term care facility to be 2.5 years, there’s no doubt that care in an assisted living facility or at an nursing home, and sometimes in your home, will run up a significant bill.

Medicare’s Limited Long Term Care Coverage

Medicare primarily focuses on acute care services, such as hospital stays, doctor visits, and short-term post-hospital care. It generally does not cover long term custodial care, which includes assistance with daily living activities like bathing, dressing, or eating.

Furthermore, while Medicare may provide some skilled nursing care coverage, it is subject to strict eligibility requirements and time limitations. To qualify for Medicare-covered skilled nursing care, you must have had a qualifying hospital stay of at least three days and require skilled nursing care or rehabilitation services. 

Even if you meet these requirements, Medicare covers only a maximum of 100 days, with co-payments required after the first 20 days. Thus, even if you qualify for some Medicare long term care services, you may still face significant out-of-pocket costs such as deductibles, co-payments, and coinsurance.

Although Medicare may cover certain home health care services, it only does so if they are deemed medically necessary and prescribed by a doctor. This typically includes part-time or intermittent skilled nursing care and therapy services, but not 24-hour home care, personal care services, or long-term home health care. 

Moreover, Medicare does not cover the costs of assisted living facilities or custodial care, both of which are essential for seniors who need help with daily living activities but do not require skilled nursing care.

Alternative Long Term Care Funding Sources

Considering the limitations of Medicare, it’s crucial to explore alternative funding sources for long-term care, such as:

Personal savings. Using personal savings for long term care is beneficial because it provides flexibility in choosing care providers and services, and helps cover costs not covered by Medicare or other insurance, reducing financial stress during a time of increased care needs.

Long-term care insurance. These policies are sold by insurance companies and may provide for services such as nursing home care and assisted living. Please note, however, that the older you are, the higher the premiums are. If you are or were employed by the government or served in the military, you may qualify for insurance discounts. Additionally, some companies allow you to trade in a life insurance policy for a long term care policy. 

Medicaid. Since Medicaid is designed for low-income individuals, you must show that you have very little in terms of assets and income. Because Medicaid has a 60-month lookback period, it is advisable to speak with an experienced New Jersey elder law attorney to put together a spend-down plan.

Veterans’ benefits. If you have served in the military, certain benefits for long term care are available. Such benefits include the VA Health Care System, Community Living Centers, State Veterans Homes, and more.

Consult an Attorney for Long-Term Care Planning

As trusted elder law attorneys in New Jersey, we recommend taking time now to consider your options for long term care. Long term care is pricey and you want to be in the best position possible should you or a loved one require such care. 

Our experienced team at The Chamberlain Law Firm can help guide you through the process to ensure that you understand the options available for your unique situation, as well as help you with money-saving strategies. Call us at (201) 273-9763 to schedule a consultation and secure your future long-term care needs. If you would like to learn more about long term care options and planning, be sure to check out our Insight Articles.

This article is for informational purposes only. It is not intended as legal advice. In the event you would like to speak with a lawyer about the specifics of your case, contact The Chamberlain Law Firm at (201) 273-9763 to schedule a consultation.

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