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Medicare

What is Medicare?

Understanding Medicare and long term care

Medicare only covers medically necessary care and focuses on medical acute care, such as doctor visits, drugs, and hospital stays. Medicare coverage also focuses on short-term services for conditions that are expected to improve, such as physical therapy to help you regain your function after a fall or stroke.

Medicare does not cover all senior living services, Medicare does not pay the largest part of long-term care services or personal care-such as help with bathing, or for supervision often called custodial care. Medicare will help pay for a short stay in a skilled nursing facility and for other senior living facilities like hospice care, or for home health care if you meet the following conditions:

  • You have had a recent prior hospital stay of at least three days
  • You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay
  • You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy

If you meet all these conditions, Medicare will pay for some of your costs for up to 100 days. For the first 20 days, Medicare pays 100 percent of your costs. For days 21 through 100, you pay your own expenses up to a certain amount and Medicare pays any balance. You pay 100 percent of costs for each day you stay in a skilled nursing facility after day 100.

In addition to skilled nursing facility services, Medicare pays for the following services for a limited time when your doctor says they are medically necessary to treat an illness or injury:

  • Part-time or intermittent skilled nursing care
  • Physical therapy, occupational therapy, and speech-language pathology that your doctor orders that a Medicare-certified home health agency provides for a limited number of days only
  • Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease
  • Medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, you pay 20 percent of the Medicare approved amount

There is no limit on how long you can receive any of these services as long as they remain medically necessary and your doctor reorders them every 60 days.

Medicare covers hospice care if there is a terminal illness diagnosis and meet other specific criteria. If you qualify for hospice services, Medicare covers drugs to control symptoms of the illness and pain relief, medical and support services from a Medicare-approved hospice provider, and other services that Medicare does not otherwise cover, such as grief counseling.

You may receive senior living services like hospice care in your home, in an assisted living, residential care home or skilled nursing home (if that is where you live), or in a hospice care facility. Medicare also pays for some short-term hospital stays and inpatient care for caregiver respite.